Topics in Palliative Medicine

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This episode examines Hypertrophic Pulmonary Osteoarthropathy (HPO), a rare syndrome often associated with underlying pulmonary malignancies. It outlines HPO's clinical presentation, which includes digital clubbing and painful, swollen joints, emphasizing the importance of differentiating it from metastatic bone pain due to its bilateral and symmetrical nature on bone scans. The text fur...

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In this episode, we discuss a complex ethical dilemma concerning a pregnant woman diagnosed with advanced ovarian cancer who refuses recommended termination and chemotherapy due to prior fertility struggles. Several experts in medicine, ethics, law, spiritual care, and social work provide differing perspectives on the case. The medical oncology perspective discusses the individualized managem...

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This case report explores the use of botulinum toxin type A (BTX-A) injections for treating post-thoracotomy pain syndrome (PTPS), a chronic neuropathic condition affecting many patients after thoracotomy. The study highlights that traditional treatments often fail to provide adequate relief, prompting investigation into alternative therapies. BTX-A's mechanism, which involves reducing i...

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I. Introduction

This briefing document synthesizes key findings from several sources exploring the potential of cannabinoids in managing neuropathic pain. The sources include pre-clinical investigations, clinical trial reviews, and decision analysis models, offering a multifaceted view of the topic. We will examine the potential of Cannabidiolic Acid Methyl Ester (CBDA-ME), the effectiveness o...

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Hiccups, while often seen as a minor inconvenience, can become a significant health issue when they are persistent or intractable. This episode explores the science behind hiccups, their potential medical causes, and treatment options, particularly the use of gabapentin as an off-label solution.

• Discussion of the three types of hiccups: acute, persistent, and intractable
• Expl...

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This case report details a patient with chronic lymphocytic leukemia whose initially misdiagnosed joint pain was ultimately attributed to the rare syndrome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE). The report discusses RS3PE's characteristics, often overlooked due to its rarity and lack of definitive diagnostic criteria, emphasizing the importance of rec...

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This retrospective study from a 21-hospital system analyzed the effect of palliative medicine consultations on 30-day hospital readmission rates for patients with six diagnoses (heart failure, sepsis, pneumonia, COPD, AMI, and stroke). The research found statistically significant reductions in readmissions for heart failure, sepsis, and pneumonia patients who received consultations. While red...

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This article presents an ethics case study concerning a 52-year-old male declared brain dead, whose family refuses to remove life support. Multiple perspectives—medical, nursing, chaplain, social work, legal, and ethical—are offered, exploring the conflict between the family's emotional denial of death and the medical team's obligation to uphold accepted medical standards. The case ...

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This case report details a rare instance of post-radiation lichen planus in a 64-year-old male, following radiation therapy for squamous cell carcinoma. The report examines the patient's medical history, clinical presentation, and treatment response to topical triamcinolone. The authors review existing literature on lichen planus, emphasizing its T-cell mediated inflammatory nature and i...

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This case report and accompanying discussion detail Posterior Reversible Encephalopathy Syndrome (PRES), a neurological condition presenting with seizures, visual disturbances, and altered mental status. Often misdiagnosed as more severe conditions like intracranial hemorrhage, PRES demonstrates reversible brain swelling on MRI. The case highlights a patient initially suspected of intracerebr...

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The BJR method is a novel mathematical approach to methadone conversion that aims to improve upon existing methods by providing a smoother, less discontinuous, and less linear output for a reasonable and safe methadone dose. Here's how it improves upon existing conversion approaches:

Addresses Limitations of the Plonk Method: The Plonk method uses a linear equation to calculate methadone ...

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The case study underscores the potential for misinterpreting spiritual distress as psychiatric illness, resulting in inappropriate treatment. 

Clinicians should learn several key lessons from the case of Mr. G, primarily emphasizing the importance of addressing patients' spiritual needs alongside their physical ailments.

Open communication: Clinicians should initiate open-ended q...

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This ethics roundtable discussion centers on the case of JG, a 45-year-old man who attempted suicide and subsequently suffered severe brain damage. The article presents differing perspectives from medical, nursing, risk management, ethics, pastoral, social work, and legal professionals regarding the ethical implications of his wife's request to withdraw life support and the physician&apo...

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Ethical and legal considerations surrounding a comatose Jehovah's Witness patient's need for a life-saving blood transfusion are debated. The patient's parents, also Jehovah's Witnesses, refuse consent, while her brother advocates for the transfusion, claiming she wasn't a practicing member. The case highlights the conflict between parental surrogacy rights, the patie...

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This ethics roundtable discussion analyzes a case study where a patient's daughter-in-law, the primary caregiver, seeks to withdraw life support, but state law restricts surrogacy to blood relatives or spouses. The discussion explores the ethical and legal implications of this restrictive law, highlighting the conflict between the patient's best interests and the letter of the law. ...

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Who makes the decision if the patient lacks capacity?  Multiple healthcare professionals offer varying perspectives on the ethical and legal dilemma surrounding the care of a 93-year-old comatose patient (JH). A conflict exists between JH's legally appointed Power of Attorney (POA), his hired caregiver, who wants aggressive treatment, and his son, who advocates for comfort care only. The...