GeriPal 300th Episode: Ask Me Anything Hot Ones Style

Anne & Lynn: Welcome to the GeriPal podcast.

Anne: This is Anne Kelly.

Lynn: And, this is Lynn Flint.

Eric: Wait a second. Whoa. What’s going on here?

Anne: You guys – today is the 300th episode of the GeriPal podcast, and we’ve decided we’re going to spice things up.

Lynn: Okay. So, today we are doing an ‘ask-me-anything’ based on the YouTube show, we’re going to spice things up. It’s called Hot Ones.

Anne: GeriPal edition.

Lynn: GeriPal edition. [laughter]

Eric: Can I ask, what is Hot Ones?

Anne: Here’s what we’re going to do today. So, in front of us today, we have a variety of hot sauces and chicken wings. They’ve all been laid out for you. Our task is simple, we are going to be sampling each of these hot chicken wings while we ask Eric and Alex questions related to Palliative care and Geriatrics.

Alex: Great

Eric: These are the questions submitted by our audience?

Anne: Right. So, we’re not totally winging it here. A variety of people, including a number of your listeners have submitted questions to ask you guys today. So, we’ve put them all together and it’s going to be great. We’ll learn a lot about you.

Lynn: And, don’t these go on YouTube?

Alex: They do. This might be one that’s better to watch than listen to.

Eric: Actually, I was going to say, this may be better to listen to. [laughter]

Lynn: Right.

Anne: For those of you who do watch, if you’re a California person, we’re taping this during local crab season. So, we’ve got our crab bibs on just to help try to keep things a little less messy today.

Lynn: Keep the splash down.

Yeah.

Eric: Okay.

Anne: But first.

Lynn: Do we have a song request?

Anne: Thank you for asking Lynn. We sure do. I was delighted to take over our first song request today, and what folks should also know is Alex’s cast has come off.

Alex: Yeah, I’m in a splint.

Anne: Congratulations.

Alex: I have two fingers to play this song with. So, I’m in the most bizarre tuning ever.

Anne: Which means he can play the guitar again.

Alex: Yeah.

Anne: So, I have request… in celebration of that, I have requested the song “Guitar Man” by Bread.

Alex: Great choice. Love this song.

(singing)

“Who draws the crowd and plays so loud, baby it’s the guitar man. He’s gonna steal the show, you know, baby, it’s the guitar man. He can make you love, he can make you cry, he will bring you down, then he’ll get you high.”

Lynn: Awesome.

Anne: You’re our favorite guitar man, Alex.

Alex: Great choice. Thank you.

Anne: All right.

Lynn: All right, all. Let’s get started.

Alex: Oh, do we eat a wing now?

Lynn: Well, first I have a question for each of you, very briefly.

Alex: Okay, we’ll wing it.

Lynn: How do you handle your heat?

Eric: I used to be good at it, not anymore. So, this is going to be a struggle for me.

Lynn: Okay.

Eric: I’m a little chicken.

Anne: All right.

Lynn: Oh! You got that one in.

Anne: All right.

Alex: Oh no-

Anne: Everybody-

Alex: I’m like a Hawaiian European guy who grew up in Michigan. I don’t handle my heat well. [laughter]

Lynn: Okay.

Alex: This is going to be rough.

Anne: Everybody grab a wing, we’re getting started.

Lynn: We’re starting with this one.

Alex: This first one is from Hawaii. This is a mango flavored salsa.

Anne: So, while you guys are eating, we’re going to throw you a few softballs.

Eric: Is this the mild one?

Alex: This mild. This is nothing.

Eric: I’m doomed.

Alex: Really?

Anne: Really?

Lynn: Oh boy. Okay.

Alex: I just feel a little tingle, nothing. Really?

Anne: So Alex, tell us, how many bones have you broken?

Alex: Oh, too many.

Anne: Too many?

Eric: Alex comes into a podcast with a new broken bone, pretty much every podcast.

Lynn: Yeah.

Alex: Playing basketball, I broke my ribs in med school and then I broke my wrist in residency. I broke my finger after that and then biking, I’ve broke my clavicle and broke my left hand and playing football I broke my finger.

Eric: Yeah.

Lynn: I thought two clavicle fractures. No?

Alex: No, just the one.

Lynn: Oh, just one.

Alex: Thank you though. Yeah, I am either a cluts or have poor bone health. I’m actually getting-

Anne: I’m super lucky to have you here today.

Lynn: That’s great.

Anne: My goodness.

Lynn: All right. Eric, here’s your first one.

Eric: I’m ready.

Lynn: Give us the steps to making a perfect latte.

Eric: Oh, for those who don’t know, my hobby is making a perfect latte in the morning. I used to like it in the afternoon, but as I’m getting older-

Alex: First, you take the frozen-

Eric: Do not-

Alex: Flash frozen-

Eric: Do not freeze your beans-

Alex: Instant-coffee out of the freezer.

Eric: Fresh beans. I keep them in a siloed, airtight lid jar.

You got to grind it, not in a conical bird grinder.

Alex: Wait, do we have two hours for this podcast?

Eric: Yeah, I can keep on going.

I will do a YouTube video just on this.

Anne: Perfect.

We have something to look forward to.

Alex: Is that have two questions, then we move on to the next wing?

Anne: Okay, so next wing, phase two guys.

Lynn: Do you want to throw them a question to think about?

Alex: This one is Chipotle flavor.

Anne: Okay, so this next question is coming from a listener named Cindy Hsu. I don’t know if you’ve of heard her, Alex.

Alex: That’s my wife.

Anne: I think she might be.

Alex: You may have seen her on Prior podcast playing piano.

Anne: So, Cindy’s out there wondering which episode of GeriPal has generated the most controversy?

Alex: That one’s easy.

Eric: Definitely MAID-

Alex: Eric knows, MAID in Canada

Eric: Medical Aid In Dying in Canada. I have never received so many emails, I can’t tell if Alex is thinking about the MAID podcast, but saying, whoa-

Alex: The spice hit the back of my throat.

Anne: This one’s smokey.

Lynn: It is smokey. Yeah.

Eric: Alex, why do you think it was the most controversial?

Alex: Because we got many, many long emails from people who practice MAID in Canada. And the US, saying that was, well in summary of the very long emails saying that we were fairly one-sided in who our guests were on that podcast. And Eric, I thought diplomatically responded how… You want to summarize? I

Eric: Yeah, I mean, just for the viewers out there who are listening, how we choose our podcasts is that we do do background to figure out who’s going to be a podcast. The ones who are publishing interesting articles are easy as we knew MAID is always going to be a controversial topic. So, we did try to get some breadth of guests on our show. But again, with any topic, we can’t really go more than two to three guests.

Alex: And, we’ve had two prior podcasts where we had guests who were very pro Medical Aid In Dying. In fact, one of the founders of Compassion & Choices or board members, I forget what his exact title was, but was on our podcast.

Lynn: This actually relates to our next question. So, a listener named Ken Hansen, who’s an Emergency Physician, wrote in about this and he noted another angle, which is that this is a topic that can be really tricky to think about across specialties because not everybody is familiar with this. So, just adding that as a comment and maybe a topic to dive into in the future, I think.

Alex: Yeah, that sounds like a future podcast.

Eric: The great thing about controversial podcasts, we like them. Our goal is to actually have controversial podcasts. So listeners, if you have controversial podcasts, email us. And, obviously that is not our last MAID podcast either.

Alex: It won’t be the last, yeah.

Lynn: No way.

Anne: Okay, everybody switch to your next wing. We’re going to phase three here.

Alex: Okay, this one people will know is Tabasco sauce is a fairly common hot sauce.

Anne: While you do that, there’s a listener out there named Jerry Winkor. He wants to know what do you guys think about the effect of private equity on hospice and long-term care? And, he specifically said quote, “you can take your gloves off on this if you want to.”

Eric: Well, Alex and I love him. If you’re going to be sponsoring any podcast, we recommend private equity, the GeriPal podcast.

Lynn: Great answer.

Alex: Oh no. Private equity is probably one of the top things that I’m worried about with the future of our field in Palliative care and that because private equity is buying up… And Geriatrics, buying up assisted livings, nursing homes, hospices at an extraordinary rate. And what is their motivation, Eric? Why are they doing this?

Eric: It’s not for their good of heart. It’s for the bottom line over the course of three to four years actually to turn over their investment. So, very short time to return on their investment, which concerns us because the hospices that probably a lot of us grew up to love and refer to are ones that have potentially been around for decades and we’re seeing more and more hospices, I always think back to our episode about this a thousand hospices just in LA County-

Alex: Thousand.

Eric: One out of six hospices, so there is financial concern, not just again with hospices, nursing homes, and now physician groups. Just the money that’s going into medicine should give everybody pause and concern.

Alex: Yeah, we need greater regulation around this, there are a lot of things we need, but attention to it, research. We need to expose this and put it upfront for people to see on a national level.

Lynn: All right, more podcasts coming, I think.

Okay, our next one, we’re going to shift gears a little bit here. Oh, and people can eat their next wing if you want.

Alex: Oh boy.

Lynn: Okay. This comes from Amy Fox. A little bit more of a personal question here, for each of you.

Do you have an advanced directive? What does it say? Might it change over time?

Alex: Eric is you’re wife, an estate lawyer?

Eric: She is. She does this stuff.

Alex: Does that mean you have an advanced directive?

Eric: I actually do not have an advanced directive.

Alex: Oh, you don’t?

Eric: I do not have an advance directive. I have talked to my wife about it, I have done many of the steps of prepare for your care. So, we’ve talked about what our wishes are, she is my default surrogate. So, I don’t see a huge value of putting her down as a durable power of attorney for healthcare.

Alex: Okay, interesting. Because I did estate planning with my wife a few years back, maybe 10 years back at this point. And, as part of that package, we completed an advanced directive. And, how useful was it? Not very useful other than assigning my wife who, as you said, would be the surrogate by default. But it sort of was like, “If you were in a persistent vegetative state, would you want to continue life sustaining treatment?”

Very specific, rare circumstance. Not the most common circumstances that people with serious illness face where attention and understanding of what my goals and values are. So, I’ve had conversations with my wife, I know we need to move on, about what my goals and values are. And I’ve said, just because I’m a Palliative care doc does not mean that you should give me a short trip. Give me a chance. I’m young.

Lynn: We got you, Alex, we got you.

Anne: You’re willing to go through some stuff.

Alex: I’m willing to go through some stuff.

Eric: The other thing Wendy says is that she’s amazed the amount of time people say, “Oh, we want to do a POLST form too.” And, she’s like, “I’m not a doctor. I cannot do a POLST form with you.”

Did you get a POLST form, try to push on you too?

Alex: I did not. That would be very concerning.

Lynn: Okay, next question. Do you ever make your kids listen to the podcast?

Alex: I don’t. But, well, yes, okay I do.

Eric: Right? On a car trip you had them?

Alex: Yes.

But really I have them listen to the songs because then they give me feedback and I change the songs before, come out to the audience, to try and improve them, because my kids have a much better ear than I do.

Lynn: What about you Eric?

Eric: I can barely talk because I’m starting to feel the heat-

Alex: I know the heat-

Eric: On the wings.

Alex: We are only on the fourth of 10. They ordered mild to hot.

Eric: I do not want my family to listen to my podcasts. [laughter]

Alex: Yeah. The problem is I can’t stand listening to my own voice. I’m sure we all have the same issue. So, I generally don’t listen to the podcast afterwards, nor force them on my family.

Anne: Well, speaking of your kids, a very special, sometimes listener, chimed in named Ren Smith.

Alex: Okay. It’s my younger one. All right.

Anne: And, Ren Smith wants to know-

Alex: 15 years old.

Anne: Alex, how did you get so good at the guitar? And, who’s your drummer?

Alex: He’s noticed that there’s drums on some tracks. Yeah, that’s not me. That is Logic Pro. Amazing AI in GeriPal right there. Right, because it’s an AI-guided drum machine that automatically senses what you’ve played and then adds in drums, which is terrific.

And Ren, thank you for the question about guitar. And, you are only three months into playing guitar and already a better guitarist than me.

Anne: Good. Shout out.

Lynn: All right. I have food in my mouth, but I’m going to keep going.

Anne: We’re on our fifth wing now.

Lynn: That’s right. I’m chewing it right now.

So, shifting gears a little bit again, we have a listener, Pegg Graham, who wrote in about functional decline over time, how rehab professionals can work together with Palliative care. And, she raises an interesting idea about access to durable medical equipment and how we should think about that.

Eric: I got to say this one, the current wing is killing me.

Lynn: Just take a nibble.

Eric: I can’t.

I can’t, I’m going all in.

Lynn: All right.

Eric: We go all in.

Man, we struggle a lot, especially when the great thing about hospices is they help organize a lot of things. But when we have people in rural areas of California, so we don’t know our clinical site, we go from San Francisco all the way to the Northern California border, super rural areas.

And, access to things like DME and all this stuff becomes really challenging. Luckily inpatient side, we got a great team. So yeah, it’s… Struggle, especially in rural areas.

Alex: Yeah, I would say that I have in the back of my mind, I had these friends who were in their nineties, Alice and Doris, I grew up with them in Michigan and they’re now deceased. But I remember having a conversation with them. I actually wrote a blog post about this when we were a blog. Remember way back when? We were a blog?

Lynn: Back in the day.

Alex: And, they were talking about how they were so annoyed because they felt like they got called so frequently by companies trying to sell them electronic wheelchairs. And, they thought, “This is a racket. Why are all these companies after me trying to get my money and get me an electronic wheelchair? I like walking around, even though I use a cane, I use a walker. I have to walk on flat… No.”

So, I have that in the back of my mind, but I also have that recent podcast that we did with the emergency medicine physician, Carmen Quatman and her sister Katie, who’s a Physical Therapist or maybe it’s Occupational Therapist, about putting grab bars like EMS providers who see these people fall again and again and again, they couldn’t do anything about it. She helped them do something about it. Take out the carpet, put in the grab bars so they don’t fall, and then fall rates plummeted. So, I have that in the back of my mind. So, I have some ambivalence over this, I feel in general, the more we can make available equipment to help people accommodate to live with disability, the better.

At the same time, I don’t want this to be another fiasco where, private equity gets involved and sees it as a moneymaking opportunity.

Eric: That’s the problem. The things that matter most to keep people at home are the cheap stuff, grab bars, things like that that requires installation versus the things that people can just like Amazon send to somebody or there are thousands of dollars may not be as helpful.

Lynn: All right, thank you. We’re moving on. So, Annie Hargadon, by the way, apologies to anybody who we pronounce your name incorrectly.

So, what are your tips to help non-palliative care docs understand what Palliative care is and how it impacts patient care? Although our field has come so far that everybody totally understands it, right?

Anne: And, this is such a hot question. You can move on to your next hot wing.

Eric: What’s the name of the next hot sauce, by the way? Because they’re getting hotter.

Alex: Oh, you want to know the name?

Eric: Yeah.

Alex: This one, you happen to ask, so I’ll say it. It’s Bubba’s Butt Blaster hot sauce.

Lynn: That’s the one Eric wanted say on air. [laughter]

Alex: We just went through Tabasco, Scorpion and Tapatío before that. Yep. Good timing, Eric. Good. What was the question again?

Anne: I hope it’s not foreshadowing.

Lynn: Alex, how come this is the one where we have the most of it on our wig?

Mine is doused in it

Anne: All right, get in there and start thinking about Annie’s question. How do you help non-palliative care docs understand what we’re doing?

Alex: I’ll go first. How do we help non-palliative care docs understand what we’re doing well? So, I was kind of reading through these questions last night. I didn’t want to rehearse them or anything, but I just wanted see, see an idea of what we’re going to be asked.

Anne: Well, this is a hot one. This is the first one that’s really-

Alex: Oh boy.

Anne: Challenged me here, sorry.

Alex: This is the second half. It goes up after-

Lynn: Oh God.

Alex: Welcome to the second half. So, we asked my older son, Kai, who’s 18 years old, he’s an adult, “What is Palliative care?” And, he said, “End of life care.”

And, then we asked Ren and he said, “Oh, it’s an SAT word” and it is in our house, he’s studying for the SAT.

Anne: Wow.

Alex: And, it means pain management.

Eric: That was the SAT answer.

Alex: So, there is an issue about the public perception of when the child of a Palliative care podcaster, the children don’t have a more full explanation of what Palliative care is, which is of course care for people with serious illness that’s provided by an interdisciplinary team and is available from the time of a diagnosis with serious illness onward and is focused on comfort and quality of life and communication and matching treatment to patient’s goals.

Eric: I’ve heard that before.

Alex: Okay. You’ve heard that before, but nobody can remember that in a short way. So, I think we need a shorter tagline. And, I know that there have been studies and efforts to create a shorter tagline for Palliative care that people can remember. I see a lot of grimaces here, Eric’s drinking a giant glass full of milk, he just poured himself a second one.

Anne: I’m crying. Am I moved by you?

Lynn: It’s moving.

Alex: And, I like Diane Meyer’s “Matching treatment to patient goals.” That’s simple. I

Eric: Would say this, I’m just going to add one more thing-

Alex: And, I’m going to eat this wing.

Eric: So, that Alex can eat the wing.

Lately on the inpatient side. I’ve been telling my team, because this is the question that comes up, “How do you introduce Palliative care?”

And, I feel like I have been making it shorter and shorter and it’s better to show one than tell one. So, let’s show them what we do rather than spend half of our time telling them what we do.

Lynn: I’d also like to put in a plug for us to do a podcast on this, because I have a lot of thoughts about this.

Alex: Okay, great, can you share-

Lynn: It’s hard for me to talk now.

Alex: A brief thought about it?

Lynn: Well, my brief thought is that in my recent transition from inpatient to outpatient, I want to make sure that we’re not signing ourselves up for more than we can handle by talking about any age, any stage, all the way along the continuum.

Anne: So, allocation of limited resources.

Lynn: You got it.

Alex: I’m sweating. [laugher]

Lynn: I know my nose is running.

Anne: The more I drink milk and do things to try to make it go away, it’s making it worse.

Eric: Milk is not helping.

Anne: It’s making me-

Alex: Oh boy.

Lynn: Do you have any bread?

Anne: No.

Alex: But I thought you were a gluten-

Lynn: I just need it. Anyway-

Alex: You can eat it anyway,

Eric: I’m going back to the first wing. It’s just to cool down.

Anne: Yeah, you guys, let’s go through this.

Alex: Good idea.

Anne: We can’t do this forever.

Alex: Okay.

Anne: Is there a dream guest you hope to convince to come on the podcast one day?

Eric: Alex has been working on one person over-

Alex: Vivek Murthy, if you are listening, if you are friends with Vivek. Lynn and I know Vivek well from residency.

Vivek, we would love to have you on our podcast. Please join us, please influence Vivek.

Anne: Okay.

Lynn: We’ll even do the wings again.

Anne: I wanted to calm you guys.

Okay, move on to your next one.

Lynn: Alrighty, so what is something that has come from the podcast that you are particularly proud of?

Eric: Not the Hot Wings episode, because I can’t even talk right now. What was the name of this hot wing, Alex?

Alex: This next one is called Ghost Pepper sauce.

Eric: Oh

Anne: Gosh, you had to ask Widera.

Lynn: I don’t know. I’m scared of this one.

Eric: Be scared.

Alex: The names are great from here on out.

Eric: I think what the question was, what was the question

Lynn: What are you most proud of from the podcast?

Eric: Oh, what am I most proud of?

Alex: I can go first if you don’t have an answer.

I’m most proud that when we started the blog, there was some tension between Geriatrics and Palliative care. And, we thought, you know what? They’re much better together than they are separate kind of like chicken wings and hot sauce. And, so we put them… No. Didn’t work, no.

Lynn: I would question that today. [laugher]

Alex: And, so we put them together and I feel like there’s been a real coming together of the Geriatrics and Palliative care communities and sort of cross-fertilization between the two and efforts between the two. And, I see a lot more working together and building on strength.

And, I don’t know to what extent that’s due to GeriPal, but I feel like in some small way we contributed to that effort, and so I’m really proud of that.

Eric: I’m proud of two things. One is our yearly GeriPal Pub Crawl at the HPM meeting. I’m proud of just how many people every year turn up to that. And, don’t forget everybody, this HPM, we got Thursday, we’ll have our Pub Crawl-

Lynn: You’re invited.

Eric: You’re invited. Everybody’s welcome to come. Stay tuned for more details.

Second thing is.

Really proud of… I love all of our listeners, but when we’re putting this together and people submitted questions, just the amount of people who also just email me from rural areas. I got two emails from rural Australia saying that they listen to our show and they like it and they submit questions. Because this is not… Our traditional academic route of dissemination is focusing on communities that don’t have a lot of access to Geriatrics or Palliative care or learning opportunities.

So, I’m super proud of being able to reach out to people in rural communities.

Lynn: Great. Okay. Okay. Go for it, Anne.

Anne: I’m trying.

Lynn: You got it. You got this.

Anne: Another listener.

Alex: Oh my-

Anne: Alex is glistening. Jessie Churchill. She asks, he or she, they ask.

Alex: She. She. I know Jessie Churchill.

Anne: Okay. She asks If you were the Czar of Geriatric care and were handed $7 trillion-

Alex: Whoa, $7 trillion

Anne: To improve the health of seniors in the United States, how would you spend it?

Alex: That’s a lot of money. I looked up the annual Medicare spending, is about one 10th that, so it’s like 10 times the annual Medicare budget.

Eric: Not on amyloid drugs.

Alex: Definitely not on amyloid drugs. What would you do with the money, Eric?

Eric: I would focus on the things that matter most. And, this will come true in Adalimumab fiasco. We’re willing to spend $50,000 a year for individuals for their expensive pharmacy medication. That doesn’t really do much, but we’re not willing to do that for caregiver support. So, focusing on caregiver support, getting not the expensive stuff in people’s house, but the things that matter most, like grab bars for those who need it.

And, then I’d also say focus on the needs of older adults, but also focus on the stuff that we know actually improves lives of older adults in the future too. So, early childhood education, all of those things help of people who are younger because when they get older, that matters as well. Alex?

Alex: I think those are great. And, I would lower the Medicare age so that there’s Medicare for all. And, that’s to help people who have serious illness, that’s to help people who have diseases of aging at a younger age, people who are homeless, people who are incarcerated.

I would use that money to help intergenerational communities foster, grow, and develop innovative ways of creating intergenerational communities. We have on that podcast about re-imagining long-term care. And, I’d do things worldwide too.

Lynn: Wow, you’re just everything, Alex

Alex: Yeah, it’s $7 trillion people.

Lynn: You have this drip of sweat on your eyebrows that I keep looking at.

Alex: Waiting for it to drop.

Eric: I don’t understand-

Alex: We still have three wings to go by the way.

Eric: I don’t understand why I’m still going back to the wings though. I keep on eating them.

Lynn: I don’t know.

Alex: This is an adventure.

Anne: Hang in there guys

Alex: Are we on the next wing, by the way?

Anne: Yeah.

Eric: Yeah, we are.

Alex: This one is called Reaper Sauce.

Anne: I need a third glass of milk.

Lynn: Weeper Sauce?

Alex: Reaper.

Lynn: Oh, Reaper.

Anne: Reaper? Oh my-

Lynn: Oh boy.

Alex: Carolina Reaper.

Lynn: All right we got one from Katie Fitzgerald-Jones.

Alex: Oh, Katie.

Eric: Hello, Katie, we love Katie.

Alex: Hello Katie.

Lynn: She wants to know how did you decide to make a podcast and how much time and energy do you put into this every week?

Eric: All right. So, when we decided to create the podcast, I think Alex’s first question was, “What’s a podcast?”

I think we started the blog in 2007 or 2008, we were doing that up until 2016. It was fun, but it was getting a little bit… We were doing the same thing over and over again. So, we’re looking for something new and we just thought we can invite guests over, we can kind of have fun with it, it’s something different.

I think me and Alex always are looking for something different. So, that’s kind of how we started it. Anything else you remember from that, Alex?

Alex: I remember we were kind of… I think we switched the order because that one wasn’t so bad, right?

Anne: That one was a welcomed moment of relief.

Alex: We needed that.

Lynn: Yeah, exactly.

Alex: We needed that.

Anne: The Reaper is a keeper.

Alex: Reaper is a keeper because the next hot sauce is called, “Regret.” [laughter]

Lynn: Oh good God.

Alex: Just so you know, we started the podcast… We were blogging when everyone was blogging in the late aughts. And, then around 2016 we were like, “We kind of need a new challenge, and that’s podcasting now.”

Love it.

I didn’t listen to a podcast before we recorded one as Eric said. And, this is great, I could see doing this for the rest of our lives and we should also be open, maybe there’ll be a new medium.

We tried TikTok.

Eric: Alex pushed us on TikTok.

Alex: There is a dance video out there, but that didn’t really take. But Sunday-

Anne: Dance video?

Lynn: Do you mean the one that’s a shot of Alex’s nose?.

Eric: Okay, “How much effort we put in the podcast?”

Initially it was some effort, not a whole lot. I think lately more and more, especially with CME, we’re putting more efforts in really thinking about the educational goals of the podcast. Definitely putting a little bit more prep time in. We used to do all the post-production work, which just took forever and it was a lot, and we’re not experts in that. So, we have Tim Stuck, who is our amazing producer.

Alex: Amazing.

Eric: Shout out to Tim. So, everybody who’s sponsored or who’s donated to the podcast, you are helping us and helping pay for those things. Like the transcription service, Tim Stuck and that helps me and Alex, Alex focusing on the songs and thinking about which guests to come, thinking about which questions to ask even beforehand.

Alex: And, we don’t benefit financially from this. It’s not part of our salary, we don’t get paid.

Anne: Which guest hosts to invite.

Alex: Yes!

Anne: Some of the most important things to think about. All right, next question. “What has been your favorite song request so far?” Do you have one?

Alex: Oh, so many.

Eric: I’m going to throw out a first. I love it, when Dan Matlock joins us. Because he asks Alex to sing some of the toughest songs. Usually like heavy metal, so Dan Matlock, I want you back on.

Alex: Yeah, we haven’t had Dan on in a while. We need to get Dan back on.

Eric: It challenges, Alex.

Alex: I like some of the ones like “Like a Stone”. By that… I forget his name. But that was a good one. I like some of those that I hadn’t heard of before and kind of learn about like the Gun Song, Lumineers?

Anne: Lumineers.

Lynn: Lumineers.

Alex: Lumineers?

Yeah, I think that was Anna Knight requested that one. And, then I have this secret joy of the female diva singer-songwriter.

Lynn: Not so secret, secret.

Alex: It’s just fun. So, when you requested for our hundredth, wasn’t it-

Eric: The Milkshake song?

Alex: “Hit Baby, One More Time?” or that was for a different-

Lynn: Yeah, it was a different podcast

Eric: Didn’t we do Milkshake?

Lynn: Milkshake, I was on that one.

Alex: Yeah, Milkshake, I did not enjoy that one. That one, no.

I really enjoyed “Halo” by Beyonce. Who would’ve thought? That was kind of fun.

Lynn: All right, well this is an interesting one given that we are sitting here eating these wings. So, Lori Wilson has a question about any new research on ways to address poor appetite that has caught your eye.

Don’t put hot sauce.

Anne: Yeah, we don’t need a publication to tell us this is not the way to-

Lynn: No.

Alex: Do we eat this one now called “Regret”?

Anne: Phase Nine.

Lynn: We’re actually doing a type of right now, right? We’re doing a type of research.

Eric: I would say this is that I am always disappointed in every medication, when I try for appetite stimulation.

We just had a surgical team, somebody’s having poor appetite. You know what they ordered?

Alex: What?

Eric: Popeye’s. They brought the patient Popeye’s, and I got to tell you, appetite suddenly improved. So, thinking a little bit outside the box, because I’m pretty sure if you had a randomized controlled trial of Mirtazapine versus Uber Eats. Uber Eats would destroy Mirtazapine.

Lynn: They would love that.

Alex: I think even though this one’s called Regret. I’ve reached the point where it’s just… I’m numb.

Eric: You regret everything else.

Anne: Do you regret?

Alex: I’m numb. It’s not as hot as it should be.

Eric: It’s like Capsaicin cream on our tongue.

Alex: Yeah, I’ve already saturated my receptors. I

Anne: I wish it was only on my tongue. I feel like my entire-

Alex: Yeah.

Eric: My lips.

Anne: Yeah.

Alex: Don’t touch your eyes.

Eric: I have a little regret from Regret.

Lynn: All right.

Anne: While Eric-

Lynn: Let’s do some more questions.

Anne: Fills up my milk glass again.

Lynn: All right.

So, from Jennifer Smith. “What about innovative strategies that you’ve heard. Any cool ideas around improving access to Palliative care in rural areas?”

Alex: Whoa, rural areas.

Well of course with COVID we had the televideo thing, which you are doing Lynn.

Lynn: I am.

Alex: Televideo Palliative care and that stuck. So I don’t know that we can call that innovative anymore. Maybe five years ago we could have said that was innovative. I actually don’t have an answer to this. And, I would love it if there are some listeners out there who have innovative ideas because I think so much of it is… The answer can’t be, you bring all of the resources of the urban environment to the rural environment.

And, some of this is people who choose to live in rural areas do so because they like that isolation. And, with that comes volunteer-only hospices, for example. On the other hand, I don’t think we should settle and say like, “You made this choice, here’s how it is.” And, that we should find innovative ways of outreach and meeting the needs of people with serious illness in rural areas.

Eric: I do think the answer for that is coming from people who are living in rural areas. So, we had one podcast with Michael Fraken about rural Palliative care… Alex, there we go. We’ve got some-

Alex: Anne can’t stop crying. She is just… Her face.

Yes.

Eric: I got to say, this one’s the hottest one I think I’ve had.

Lynn: Last one?

Eric: No, that was Regret. We have one more.

Anne: I think I’m [inaudible 00:33:29] a little.

Eric: And, so we had Michael Fraken on, it’s people like that who are living in rural areas who are going to come up with the answer. It’s not big academic centers because the big academic centers are in urban areas. They don’t know the needs of those in rural areas. So, if you know of interesting stuff out there, people doing interesting Palliative care, Geriatrics in rural areas, shoot us a message.

Lynn: Let’s do a podcast about it. Yeah. Okay. From Pegg Hieric. This came up recently in some conversation, “What do you think about the idea of mandating all nursing home residents to have a POLST form-

Alex: Oh boy.

Lynn: Regardless of their code status, regardless of their short stay or long stay status?”

Alex: I think the idea is intuitively appealing but flawed on closer examination. You might think the norm for nursing homes should be a Palliative care focused type of care, and that should include a POLST form for every patient. But in reality, there’s all sorts of people under that roof in the nursing facility.

There are those long stay patients who have serious illness or whom POLST is appropriate, who have a shorter life expectancy, for example. And, then there are long stay patients who have a relatively long life expectancy. There are also increasing proportion of people in nursing homes who have serious mental illness.

There are some short stay patients in there who are there for some acute rehab. And, so I think as policy, everybody in nursing homes getting a POLST is deeply flawed.

What do you think?

Eric: Why do I keep on turning to my Regret here? [laughger]

Lynn: You’re going back to that one?

Eric: Regret. Regret. This is the chicken wing sauce. In the state of California, it specifically says it can’t be mandated. We shouldn’t be mandating individuals, this should be an optional thing for individuals. You can have policies in the nursing home encouraging people to do it, but it should never be mandatory.

Anne: We just had a patient this week where we were having a conversation about talking about providing education on what is a POLST form, when do we use it. And, earlier this week Eric mentioned he was like, “The POLST form is a tool that should be a product of a conversation when appropriate.”

I think just because someone has a POLST form doesn’t mean someone sat down and had a very thoughtful goals-of-care conversation with them to inform the way to filled out the form, right?

Alex: Yeah.

I think a lot of nursing homes these days, they sort of hand it out like, “Fill this out and I’ll come pick it up later.”

Eric: Or in the lawyer’s office, shockingly.

Alex: Right, right.

Lynn: Yeah.

Anne: Okay. We’re in the final stretch here guys.

Lynn: All right.

Eric: Does that mean we turn to our last one?

Anne: You’re on your last wing.

Lynn: Yeah, last one.

Anne: What is it called?

Alex: We’re on our last wing. Okay, this one is called The Last Dab and thank you to Hot Ones, this is not a Hot One sponsored episode.

Although you could be if you wanted to sponsor us, but we are giving you credit where credit is due for this idea and we’re using your Hot Sauce. This one’s called The Last Dab.

Lynn: This is actual hot sauce from that show.

Alex: Yeah, from the show. It’s called The Last Dab and it’s traditional last hot sauce.

Anne: That mean it’s really hot.

Lynn: Oh gosh. They didn’t gift it to you.

Alex: No they didn’t. We bought it, purchased.

Anne: Which episode of the GeriPal podcast has most significantly changed your clinical practice?

Eric: I’m going to throw out Katie Fitzgerald-Jones. We mentioned her name before. She pushed us to do an episode on Opioid Use Disorder, on Buprenorphine. I think her, our pharmacist here who also pushed us to start thinking of Buprenorphine. I think that has been my biggest change in my clinical practice as far as prescribing is thinking about how we can better care for individuals and think about the risks of Opioids too.

Alex: So many, I remember in Palliative care fellowship learning how to prescribe Tramadol and even giving a talk at the general on pain management and recommending Tramadol. And, then we did that podcast with David Jerling “Trama-Don’t.”

Terrific, so memorable. And, he is just such a great speaker in the way he describes it. But that’s only one of many. And, like Eric said, I’ve started to prescribe Buprenorphine more frequently. I’ve also changed the way I talk with patients.

I’m much more likely to ask patients if they feel lonely now. And, I’m much more likely to use the Harvey Chochinov “Brief Dignity Inventory” question about things about themselves that are important to know in order to take the best care of them possible.

Lynn: Awesome.

Thank you. I have to say those all stand out for me as practice changing ones too. Especially OUD.

Anne: You know what stands out to me?

Lynn: Yeah?

Anne: That Lynn hasn’t taken a bite of her last wing.

Lynn: I did. I took a nibble.

Anne: Oh, you skipped another one then.

Lynn: No, that was his one.

Anne: Did I nibble it?

Lynn: I started nibbling because I realized maybe you wouldn’t be able to talk.

Anne: You should have let us know your strategy.

Lynn: Okay, the truth is out. I cheating a little bit.

Okay, so I think we’re going to wrap it up here. The question is… This show is kind of reminding me of sitcoms where they do the flashback episode. Do you know what I’m talking about?

Anne: The slow motion montage?

Lynn: Kind of. Yeah, where they go back and show famous clips from all their best shows.

“If people want this show to keep going and they want you to do it for the rest of your life as you promised, Alex, what can our listeners do to support GeriPal?”

Alex: It’s funny, I turned 50 this week and my older son Kai asked, what are your goals for the next 50 years of life Daddy?” I loved that he asked me a Geriatrics and Palliative goals-of-care question and 50 years is a long timeframe. I was like, “Kai, what are you going to do for the next 50 years until you’re 68?” I would be happy to do this podcast because the main thing work related, and I think that’s what we’re talking about here that I want to focus on is helping people. And, I think we do that through our podcast and that’s why we do this, listeners.

And, if you want to support this effort, if you’ve drunk the Kool-Aid or ate the hot sauce of the Geriatrics and Palliative care, there are so many ways you can help. And, I’ll start us off by one, and this is completely free. Like us, subscribe to us on your podcast feed. Like us on YouTube, leave a comment on YouTube, we’re trying to boost our YouTube viewership, which is more international than the podcast’s. And, leave a comment, leave a rating. And, that helps us. That helps us grow, Eric.

Eric: I’d also say we talk a lot about thanking our supporters donations. We’ve encouraged a lot of people to sign up for CME. If there is one thing that we need the most from our listeners is exactly what Alex said is share our podcast like it. Go on YouTube like that, that’s actually how we grow our podcast.

Again, we’re not into this to make money, we’re into this to grow the podcast, get more people interested in Geriatrics and Palliative care and the great work that people are doing. And, that’s the great thing about inviting guests over is we get to disseminate the great things that they’re doing. And, that’s the point of the podcast. So again, encourage everybody, just share the podcast.

Lynn: Great, thank you.

Anne: Well you guys, you have risen to the challenge of asking anything Hot Ones GeriPal edition.

Alex: I know, I think I need a shower.

And, that last one wasn’t so bad, was it?

Anne: No. I don’t know

Lynn: I didn’t like the taste of it that much.

Anne: Hot is hot.

Lynn: I feel it over here.

Anne: So, we have one.

Eric: We all have oranged lips too. [laughger]

Anne: We’re going to end on a second song request today.

And, our finale song request goes to Lynn.

Lynn: So, I would like to request “Long Live” by Taylor Swift.

Alex: Oh surprise.

Eric: Lynn, why are you requesting this song?

Alex: Lynn’s that huge Taylor Swift fan.

Lynn: I’m a huge Taylor Swift fan.

And, when I think about celebratory songs that are celebrating a milestone, this is one of those songs. It’s a little cheesy but it’s really fun.

And, Taylor wrote this song when she was at… She thought she was at the top of her game in 2010.

Alex: Oh.

Lynn: And, look where she is now.

Alex: Look where she is now.

Lynn: So, I thought, “Look where you two are now.”

Anne: Lynn moonlights as a Taylor Swift biographer.

Alex: She’s bigger than the Super Bowl people. All right here we go.

(singing}

“I said remember this moment, in the back of my mind. The time we stood with our shaking hands, the crowds in stands went wild. We were the kings and the queens, and they read off our names. The night you danced like you knew our lives, would never be the same. You held your head like a hero, on a history book page. It was the end of a decade, but the start of an age.”

Lynn (invite to sing along)

“Long live the walls we crashed through, how the kingdom lights shined just for me and you. I was screaming, “Long live all the magic we made, and bring on all the pretenders, one day we will be remembered.”

Anne: Thank you everybody we’re going to get Alex a cold towel.

Eric: Oh no.

I forgot to click record. We got to do all the hot wings again. [laughter]

Anne: Thanks everybody.

Alex: Thank you.