Geriatrics Overview in Haiku

I gave this lecture during a Geriatrics Grand Rounds to Family Medicine Residents when I was still in Academia.  I miss teaching.  However, there is no reason this should remain locked on my USB power-point.  Could I try to submit it to JAMA or NEJM?  Certainly!  But it’s just so much easier to post it on a blog.  Enjoy!  Mind you, it’s way better in person and live with me, naturally.  Also, it’s meant for physician learners, in particular internal med and family med (primary care).  Still there is probably something for everyone in these Haikus regarding the care of our Elderly.

It's Geriatrics
The real art of medicine.
Have to use your brain.

No rules for aging,
Protocols are rough guidelines.
Sherlock Homes-ing it.

Physiology 
Of aging needs understood.
A lot common sense.

Kidney and liver
Normal decreased functioning
Can't handle as much.

Muscle mass goes down
Lipophilic things linger
Changes kinetics.

Genetics start it,
Add lifetime of divergence.
Not predictable.

Don't live forever.
Must counsel on prognosis,
Cut back futile care.

System is broken
Medicare incentives wrong
Creates more problems.

Want Geriatrics?
Pay for time instead of pokes!
It's quite simple math.

Falls are so common.
Many are preventable.
Don't rush your old folks.

Falls cause M and M.
Leading cause of death in old.
Script Responsibly!

Prevention can help.
Small exercises better
Than zero motion.

Polypharmacy
Beers is theoretical
Use the STOPP/START tool.

Pharmaceuticals
Pharmakos Greek for Poison.
More is not better.

The memory loss.
Alzheimer's is dementia.
Need to educate.

Care for Dementia
Is not based on prescriptions.
Treat the Caregivers.

We've staved off death from
Heart, kidney, cancer disease.
Can't replace the brain though.

Frailty's many signs
Do not ignore them up front
Your patients suffer

Unwanted weight loss
Multifactorial Gait
Disorders are rough

Incontinence is
A rampant problem for all.
Depends are your friend.

Delirium yikes!
Can stop it before it starts
In certain cases.

If medical cause
Treat that first and pray for best.
Antipsychotics?

Haldol is no cure.
Often complicates things more.
Only for danger.

Exercise is good
No matter how old you are.
Even if in chair.

What's the fracture risk?
It's Osteoporosis!
Find it and treat it.

No movement also
Leads to more pressure ulcers.
Good luck with those wounds.

Loneliness and the
Isolation that causes 
Poor quality of life.

Individuals
Need community to thrive
Or else depression.

I'm in my thrities
Retirement community
Sounds like my heaven.

Hypertension kills
Do does hypotension peeps
Brain needs perfusion.

Systolic one-ten?
Consolidate and cut back
BP medicines.

Low blood sugars are
More danger than the high ones
In elderly folks

If A1c low
Sugars are going hypo
You just ain't seeing.

Metformin still great
Sliding scales are bad news bears
Basals are more safe.

Don't undertreat pain
Quality of Life matters
Tylenol safest

If need something more
Narcotics low dosages
Stool softener too.

NSAIDS are no good
For very elderly folks
Bye bye to kidneys.

Geriatric peeps
Not the cause of opioid 
Epidemic here.

What is DNR?
Everyone seems quite confused.
AND more clear.

Advanced Directives
Not around when needed Most.
Document these talks.

Maybe one fine day
All states will adopt the MOST
Make our jobs better.

Parkinson's disease
Does not require neuro doc
PCP's can treat.

If you are worries
Read up for your patients' sake.
Don't delay Levo.

That's one example
Where we rely far too much 
On specialty care.

You are doctors too
Diagnosing and treating
Not just referring.

Too many cooks in
A much fragmented kitchen
Leads to huge grease fires.

That's our EMRs
That don't communicate or
Produce quality.

Bad system ok
For relatively simple
Not for old and frail.

As so it happens
No replacement for judgment
And good physicians.

 

2 comments on “Geriatrics Overview in Haiku

  1. Dear Dr. Tapia,

    I stumbled upon your blog via a FB post linking to one of your blogs picked up by KevinMD. I was drawn to your name—my husband’s last name is Tapia. I read the post about your husband asking how you handle so much death. And, I read your post about Wonder Woman too—which I really loved!

    My mother died on March 7. She was 2 months past her 71st birthday. She had been very sick with so much co-morbidity for most of her life, including heart disease (with a 4-artery bypass), breast cancer, diabetes, kidney disease, anemia, endometriosis, and rheumatoid arthritis.

    I was an only child and for the last 17 years I helped her navigate her ever-deteriorating health. I kept an 8-page document of her medical history and medications. I came to speak about her conditions and give her history so easily and thoroughly—using the correct medical jargon—that people in ERs and doctors offices on first visits would frequently ask me if I was a medical professional. “No,” I’d say, “I’m a graphic designer at Texas A&M’s College of Veterinary Medicine & Biomedical Sciences, but I am an expert on my mother’s health.”

    We finally engaged palliative care and quickly hospice 6 months before her death. She spent the last 5 months of her life in a nursing home. She was so anemic in the end—8 transfusions in 2016 alone—and the last few were without much time in between and started causing uncomfortable side effects. Prior to the nursing home, she’d lived in an independent living apt. at a HUD retirement community—but close to us and seen by my husband or myself 4-7 times a week and talked to via phone 3-5 times a day. I’d accompanied her to all of her medical appts. since 2000.)

    I just read through this post and your brilliant, and in my limited experience (only limited by the number of individuals—certainly not in actual experience with my parents), all completely and absolutely true haikuths really hit me hard—in really wonderful ways. The one about NSAIDS and kidneys, the one about low blood sugars being worse than highs, and the one about not needing too many specialists are my favorites.

    One of my most treasured victories in the last two months of Mama’s life was having the hospice medical director agree with my suggestion (sent via the social worker to a case meeting about my mom) that they let her sugar be consistently higher than they were allowing it to be. She was a woman who had had such high and out of control diabetes for almost a decade and now that it was so controlled and so low (for her) [because her meds and diet were better controlled at the nursing home than she and I had been able to achieve at her home], she was having psychiatric issues. I don’t deny there were other factors at play—but sure enough, when they let them climb just a little higher, by reducing the ridiculous amount of daily insulin, the issues improved (they didn’t disappear completely, but they improved)! And, in a situation where you know someone is not going to ever be well again and is dying—an improvement can mean so much for quality of life.

    Anyway, I have no regrets that my mother and I did the very best we could. And, we were blessed that the end was relatively quick and very peaceful. However, I continue to work through the whole experience. I really feel like finding your blog is going to be such a huge blessing of validation for me as I continue through this odd journey of relief + grief.

    Thank you for writing. And, thank you discussing the hard stuff. I’m a big believer in talking about uncomfortable topics openly. I look forward to exploring more of your posts and being subscribed to your blog for future posts.

    With gratitude,
    Jennie L. Lamb
    College Station, Texas

    • shannontapiamd@gmail.com

      August 22, 2017 at 7:54 pm Reply

      Jennie, I apologize for not seeing this sooner. I have been on a bit of a hiatus from writing lately and haven’t logged in until now. Truthfully, a dear friend passed away this summer and other than the blog post I wrote about it, I’ve taken some time away to grieve and also try to really discern what I want to do with my MD. Thank you so much for your kind words and I am so sorry for your loss, and the struggles you endured to advocate for your mother’s care. And you have indeed motivated me to keep this blog going…..once school starts of course (I can’t complete a thought with kids around!). I have a facebook page called medicine on tap that is public. It’s been neglected recently, but if you ever want to get in touch otherwise, I’m on FB far more than my WP blog. All the best. Dr. T

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