Episode 108 | The Care Nobody Explains BUT Could Add Years to Your Life with Dr. Lisa Tartaglia, Hospice and Palliative Medicine Physician

[00:00:00] Dr. Katie Deming MD: Hello everyone. I'm Dr. Katie Deming, and this is The Born to Heal podcast where we share practical tools and knowledge to help you create conditions for true healing in your life.

[00:00:10] Dr. Katie Deming MD: Let's welcome Dr. Lisa Tartaglia, osteopathic physician who is dual board certified in palliative care and Hospice. Dr. Tartaglia, thank you for being here. It's so nice to see you.

[00:00:23] Lisa Maria Tartaglia: Thank you so much for having me, Dr. Deming.

[00:00:25] Dr. Katie Deming MD: My audience doesn't know this, but you and I met a couple years ago. That was 2022. and we have a lot of overlap in our careers and our interests, and

[00:00:38] Dr. Katie Deming MD: I think what people are interested in knowing, like out of the gate is like, what is the difference between palliative care and hospice? I think people get those confused and are not sure about that.

[00:00:50] Dr. Katie Deming MD: So why don't we start there?

[00:00:51] Lisa Maria Tartaglia: Sure. Absolutely. So palliative care is any patient that has a chronic illness without a real cure. So it can be like [00:01:00] congestive heart failure of people that are, have, their activities of daily living, like they're short of breath, they're having trouble, eating because they're, because of their shortness of breath.

[00:01:09] Lisa Maria Tartaglia: If it's de, if it's. Working in the sense that, these illnesses are causing them pain or discomfort or, trouble with their activities of daily living. they really are palliative patients. So in my population I practice in, Florida, I see a lot of senior citizens because they retire here in this.

[00:01:29] Lisa Maria Tartaglia: State and they have come with a lot of comorbidities, a lot of medical diagnosis and it's very hard for them to get into their physician's office to be seen. And it's also very hard for their symptoms to be managed 'cause they're in a five to 10 minute, window. with the doctor. so what, as a palliative physician, I work on treating the whole patient, which means, I work on their psychosocial, how their house, I make house calls, so what their house looks like, how can we set it up to eliminate, signs and [00:02:00] symptoms of their disease.

[00:02:01] Lisa Maria Tartaglia: And then also, medication management. And, also I try to to bring in the family or any type of, caregivers that are helping the patient in their home. the difference between hospice care, I started my career as a hospice physician, 20, uh, years ago. hospice, you have to have a terminal illness with a prognosis of six months or less.

[00:02:26] Lisa Maria Tartaglia: So that's the main difference. these patients can cross over to palliative. Right. And, and sometimes hospice patients live a long time. Like right now, currently in my practice, I have several hospice patients that I follow in a palliative arm. I see them in their home. I coach them, I guide them. I'm. looking big picture at all of their diagnosis, and they've been on hospice for three years.

[00:02:49] Lisa Maria Tartaglia: They're, they are terminal, but with all the care that they have in place, they are living a good life.

[00:02:54] Dr. Katie Deming MD: this was one thing that as a physician, when I was practicing in [00:03:00] radiation oncology, palliative care was a huge part of my practice because. I would refer out for anyone who needed help with the management of the symptoms. If they had, and this was at where I practiced, if someone had like, maybe not an early stage cancer, but didn't have to be a stage four, but like an advanced stage cancer where they had symptoms related to the diagnosis, they were eligible for palliative care.

[00:03:28] Dr. Katie Deming MD: And I would always encourage like, let's. Involve people who can help us with getting pain under control or getting symptoms. Who can also look at things like you said, they don't have a five minute appointment slot. They can really look at the, the things that are, the dynamics, like the social dynamics that are playing into their symptoms and the way that they are living.

[00:03:52] Dr. Katie Deming MD: And so is that correct? Am I correct in understanding that other people who don't necessarily have stage four would be. [00:04:00] appropriate for palliative care.

[00:04:01] Lisa Maria Tartaglia: Yes, absolutely. So it's more of, cancers that are maybe stage two, stage three. It's really like. You hit the nail on the head, Katie, when you said it's about symptoms. So some patients may have an advanced cancer and have no symptoms, which, you know, by golly, that's amazing, but most people have some kind of debilitating, symptomatology that shows up either due to chemotherapy or radiation therapy.

[00:04:26] Lisa Maria Tartaglia: And that's when a palliative, team would go in and help them in their home manage those symptoms and then be allowed, allowing them to continue, their treatments.

[00:04:36] Dr. Katie Deming MD: And for me, the things that I saw in my practice with involving palliative care was that people did better if we had help because the other thing. That you think about, it's like doctors are not experts in pain management, right? So even oncologists, and most of my audience, I would say most of the people who come and listen to [00:05:00] my podcast have some interest in either preventing cancer or healing cancer.

[00:05:05] Dr. Katie Deming MD: So that's a big lens that I see the world with, but. I really loved having palliative care on board as early as possible if someone qualified because it just gave more eyes on. And then also people with expertise that I didn't have to help manage, okay, what is the right pain? Me medications if someone needs that.

[00:05:27] Dr. Katie Deming MD: And so from your perspective of being on the other side, is it the same thing, like do you feel like the earlier that people are able to engage in these services. The better that they do.

[00:05:38] Lisa Maria Tartaglia: Yes, I agree with that. a thousand percent, the better that they do and also the better, that patients are prepared, for their illness. I often tell my cancer patients, for example, When they start to identify as a cancer patient, that's when we have trouble. So I do a lot of work with my patients to not identify as a cancer patient, [00:06:00] to identify as, yes, I have this illness that's in this box, but I am this person in this box and I want to live and I want to heal and not let the whole.

[00:06:09] Lisa Maria Tartaglia: Diagnosis, consume them. So I find when we talk, have those conversations and I meet with them by phone, you know, I'm always available by text and I give pep talks. That's when these patients do really, really extremely well, because they have compartmentalize their disease and not made it their whole, being.

[00:06:29] Lisa Maria Tartaglia: And also when, obviously when you're nausea or pain or anxiety, all those symptoms are managed, you're gonna feel better, right? If then somebody that's, you know, really upset in bed, they can't get up. They're so weak, they have nobody to talk to. They're calling their, you know, oncologist. You can't, you don't get a call back till the end of the day.

[00:06:49] Lisa Maria Tartaglia: Sometimes it's 24 hours. So at least if they have all these tools in their shed. They know how to, um, operate and I explain each medication, how to utilize them. [00:07:00] And then also I also talk about alternative things such as like acupuncture, osteopathic manipulation. There's a lot of adjunct treatment. different types of aroma therapy for nausea really help.

[00:07:11] Lisa Maria Tartaglia: Amazing, you know, a lot of these kind of things can really help when you're treating the whole person.

[00:07:16] Dr. Katie Deming MD: and I love what you started that with about. That you're not your disease, right? Like, and this is actually one of the things that I think is really challenging for people who are experiencing cancer, is that it takes over their world and it feels like everything in their life revolves around that.

[00:07:38] Dr. Katie Deming MD: And you're right, that the people who do the best are the ones who are able to say yes. Like, I'm, I'm dealing with this. This is something that is going on, but this is not who I am. Like I am not identifying. And as you know, like I don't like the word survivor. And these like terms that we put people, these labels that we put on them that we don't even realize [00:08:00] the.

[00:08:01] Dr. Katie Deming MD: Implications of that. And I'm not saying like, I think, I think people know this, but if not, like I, I'm not saying you can't use Survivor to identify yourself if that fits for you, but it's like we do this like where we blanket label people and then put 'em in these boxes. And that's not like, you know, each one of us, if we're dealing with an illness, like, I'm still Katie, I'm, I'm healing something, but I am this whole person and what I am.

[00:08:29] Dr. Katie Deming MD: You know, wanting to do is to find out what is this illness telling about me? How can I learn and shift things and heal it, but not to let it define me? So I, I love that you bring that up. And I love also, you know, there's so many things that you can do to manage symptoms like you were just describing essential oils and that.

[00:08:50] Dr. Katie Deming MD: People like yourselves who are trained in this, know all of those little things. And you're absolutely right. When someone's anxiety and nausea and pain [00:09:00] and all their symptoms are better managed, they're able to live, you know, and really have a better quality of life. And I think really that's what this comes down to is, is really focusing on people living.

[00:09:13] Dr. Katie Deming MD: Like it's how can we live is the way that I see palliative care and frankly, hospice too. It's like, how do I live for whatever time that I have left? How do I maximize that? And I love that you brought up that you have a client who's or patient who's three years on hospice. It's like just because they, that this, you know.

[00:09:33] Dr. Katie Deming MD: Requirement needs to be met to be put on hospice. It doesn't mean that like, oh, though you'll just have this amount of time and then it's like, you know, we're pulling out or you have to die or something, you know, silly that I think people think that is like, that means, but it's just that, that's just the criteria for coming in there.

[00:09:51] Dr. Katie Deming MD: So. And tell me like, just like give some examples of some of the things that you know you do with people who are [00:10:00] experiencing cancer that help with their symptoms. Like what are some of the things that you do as a palliative care physician?

[00:10:05] Lisa Maria Tartaglia: Well, a lot of times it just starts with, um, understanding what they know about their disease. I always meet people where they're at. So there are some patients they wanna know everything about their disease, they've. They're well versed. They've read every study, you know, they're on, you know, doing Google, um, Google searches and things of that nature.

[00:10:25] Lisa Maria Tartaglia: And, um, there are other patients that, like I said, don't really wanna know a lot. So I meet them first as to what they want, want to know, and then what are their desires and each person is so. unique. Like recently I had a consult with a patient and she wanted, her goal was to see her great-grandchildren be born and they were gonna be born within one month of each other and how she could visit them.

[00:10:51] Lisa Maria Tartaglia: And she had, uh, abdominal cancer. So she had a lot of symptomatology, like a lot of shortness of breath and a lot of, um, [00:11:00] abdominal pain and really. diffuse nausea that anything she ate, she would become really, really nauseous. So I did a lot of, um. Acupressure points with her. Um, we did a lot of breathing exercises.

[00:11:12] Lisa Maria Tartaglia: Uh, I taught her and I invoked other people that could help her with that. And then, we just kept making a vision board of what she wanted to go after. And she was, she was a strict palliative patient. She was not on hospice at that time ‘ cause she still wanted to continue. Uh, aggressive therapy to try to keep her symptoms at bay.

[00:11:34] Lisa Maria Tartaglia: And what I realized with being very open and honest with her, um, and using all these adjunct treatments is she created a real nice trust with me that then when I brought in western medicine, like some pain management narcotic use. Alytics, which are, you know, anti-anxiety medicines. She was more apt to try it because we've tried all these other things and they were helpful, but not a hundred percent helpful.

[00:11:59] Lisa Maria Tartaglia: [00:12:00] so I just meet, you know, in summary, I just basically meet patients where they're at and each patient is very, very unique. And what was interesting about this, lady, is her symptoms kept worsening. And her family kept telling her, no, no, no, you're fine, you're fine. And she couldn't stand hearing that.

[00:12:16] Lisa Maria Tartaglia: So she shared that with me. And I also worked with the family on, let's rephrase this, because none of us are in this room with stage four cancer and we really don't know if she's fine, so let's try to figure out different words to communicate. And at, at the, um, unfortunately, her life did. You know, it was sad, but she ended her life with such peace and closure with all family members that were having a very hard time accepting.

[00:12:42] Lisa Maria Tartaglia: and she lived her life to the fullest doing everything she wanted to do. you know, and she had a very peaceful passing.

[00:12:50] Dr. Katie Deming MD: Well, and I think that. You know, I mean, all of us at some point are gonna leave, right? Every one of us who comes in here has an expiration date, and I know [00:13:00] that we don't like to talk about these. And actually, I think like people even see the name hospice and then they're like, oh, I don't wanna talk about that.

[00:13:05] Dr. Katie Deming MD: But the truth is all of us are gonna leave at some point, and that. That idea of making the most of what time someone has and then also really working on the whole ecosystem of the family because, and this is a big piece of my current practice. And then, and frankly I did this before just because of the way that I approached my patients, but is like really understanding.

[00:13:33] Dr. Katie Deming MD: Like you, like what language? Like what is helpful for the people around you that love you? They're also coping, right? They're also coping with the distress of the illness and we, you know, we often think about it, it's just the person who's sick, but it affects everyone else. And if you can help those other people find language and have tools to be there and support their loved [00:14:00] one and find, you know.

[00:14:02] Dr. Katie Deming MD: Forgiveness or closure in relationships so that everyone feels at peace with what is naturally happening. That's like a gift. It's beautiful, you know? And I think that it, it, that's what drew me into medicine in the first place, was actually hospice. Being around people who are facing the end of their life.

[00:14:21] Dr. Katie Deming MD: And I was like. This is incredible. Like you find out like really what matters really fast by hanging out with people who are facing the end of their life. So, yeah, I just, I love all of that and I wonder for you, like, what is it that draws you in? Like, what is it, why do you do what you do? What, what about this is fulfilling for you?

[00:14:42] Lisa Maria Tartaglia: What I love about it is I connect with patients. Um, a lot of times these patients feel like they've been disposed of by their physicians. I mean, I, I, I hate to badmouth our colleagues, but they, that's their perception is that they were dumped or they're too sick for anybody [00:15:00] to handle. And what I try to do is normalize, um, their disease.

[00:15:04] Lisa Maria Tartaglia: They're more than their disease. They're, that's like only part of their entity. And, and try to just prepare them, uh, for their journey, wherever their journey takes them. If it's gonna be three years, two months, some patients only meet for one day and they transition. and I. What drew me to it honestly, was, when I was graduating from medical school, I'm a hundred percent Italian and we do things backwards in my family, so my parents threw me a surprise graduation party actually before I received my diploma.

[00:15:35] Lisa Maria Tartaglia: And, um, my grandmother was very ill, which I kind of knew but really didn't know 'cause I was just graduating from med school and I had been away from her for four years. Um, but she had end stage congestive heart failure and was very sick. And, uh, this was in the early two thousands, so palliative wasn't really.

[00:15:54] Lisa Maria Tartaglia: Anything. It was more hospice and, you know, that was like a bad word to say in my family. and she [00:16:00] had a massive stroke, at my party, like the stroke was evolving and the next day she didn't wake up. And, uh, here I was like two days before going to my graduation, uh, my grandmother had me as her power of attorney healthcare surrogate and how to make really hard decisions for her.

[00:16:17] Lisa Maria Tartaglia: I was just really to torn of, you know, what decisions to make. Even though we have had so many conversations and the decisions I had to make were not easy for my family to accept, and, um, I had to kind of push my father in positions he never wanted to be in. He thought signing my grandmother up to hospice was like a used car deal.

[00:16:37] Lisa Maria Tartaglia: And the whole time I sat with my dad handling everything, I thought, you know, this, this, my grandmother was my greatest teacher, my best friend. And in her dying she taught me something else. Like I was gonna do family medicine. But I was drawn to do hospice and palliative because I thought this is how unprepared we were.

[00:16:55] Lisa Maria Tartaglia: And I'm a, I'm was studying to be a physician, so I never wanted it to [00:17:00] be that people are unprepared. So I've always taken like a really, staunch seat where I will go against other colleagues in this sense of prognostication and help patients understand their disease process completely so they can make educated decisions.

[00:17:17] Lisa Maria Tartaglia: So that's really what drew me to, it was my grandmother.

[00:17:20] Dr. Katie Deming MD: Wow. Well, and it's interesting because I had this happen. This was just like. Maybe like six weeks ago in my practice. And there was a woman who she came to one of my fasting information calls 'cause she was interested in fasting for her mom. And her mom was like in her eighties and she had like mild cognitive impairment, probably early dementia.

[00:17:44] Dr. Katie Deming MD: And had been diagnosed with an endometrial cancer and, and the mom was like stopping the eating and stuff. And I, I was like, I think you just like, let's just do a one-on-one consult and see like what she needs. And when I got on the consult. What they were describing was someone who [00:18:00] was dying. Like literally, I was like, oh, this is someone who's gonna probably die within the, like the next two weeks.

[00:18:06] Dr. Katie Deming MD: And this family has no idea that like GYN oncologist was pushing to do chemo and they were like, it's not, you know, we don't wanna do surgery right now. We should do chemo first. But she had. Stage four disease. And the family didn't know that. The family didn't understand that. And she had like, ascites.

[00:18:24] Dr. Katie Deming MD: So she had her fluid full of, uh, her abdomen full of fluid. And then she was also accumulating in a, pleural effusion, so fluid in her lungs. And I mean, and I'm in this new practice, right? So they were just coming to me to talk about fasting and I. I had to say to them, I said, you, you definitely need to call your doctor.

[00:18:44] Dr. Katie Deming MD: Like now. It was like we were on this call, it started at four o'clock and by like four 40, I'm like, you guys, it was a Friday afternoon. I'm like, you need to hang up now and you need to call her doctor and you need to tell them like this, like to say these symptoms exactly the way that I'm saying to you, [00:19:00] because I think the way that they had been communicating them, maybe it didn't.

[00:19:04] Dr. Katie Deming MD: I don't know if the family was downplaying it or not, but clearly like the picture that I put together, I was like, clear, this is in a bad spot. And I definitely, they were gonna put her through some procedure. I can't even remember what the procedure was the following week. And I was like, oh my gosh, I would just time out everything.

[00:19:21] Dr. Katie Deming MD: Just call your doctor right now. And then I got a message on Tuesday that she had already died and I had seen her on Friday afternoon. So what you just said there. Happens all the time and that, and I don't, I don't, I don't wanna say that those doctors were misleading the patient, but I definitely, the family had no clue.

[00:19:43] Dr. Katie Deming MD: And like all of them were crying as I'm having this conversation and I'm thinking like, oh my gosh, am I like off track? 'cause I'm just meeting this person, but clinically I'm putting this together and like. You guys need to actually get with someone right away. So what you just said is very true and happens [00:20:00] every day.

[00:20:00] Lisa Maria Tartaglia: Yeah.

[00:20:01] Dr. Katie Deming MD: Yeah.

[00:20:02] Lisa Maria Tartaglia: does. And when I started my business, four years ago, I, I was, like I said, I was a hospice medical director, so I oversaw hospice care in South. I, I was primarily in Palm Beach County, Florida. And that now I live in central Florida, which is near the Orlando area. so. But again, I'm in a retirement state, you know, lots of retirees and stuff, and what I found, the biggest thing that I found when I would be going, I would always have to go to the difficult cases.

[00:20:31] Lisa Maria Tartaglia: I'm like, oh, what does that mean? Well, the family will not sign consents. Well, in my mind, if we as the medical director of a hospice cannot have patients sign consents, there is some disconnect in communication. It doesn't really require a medical director, but I have really good skill of, of helping, and I would just explain the whole picture.

[00:20:52] Lisa Maria Tartaglia: And at the end, I can't tell you, I, I, if I had a, a dollar or a dime for every time patients would say, I cannot believe [00:21:00] it took me to be dying, that I have to sign this piece of paper for somebody to put all the pieces together. So I just think a lot of times. Patients are looking for all these answers and they'll take one word from this practitioner, one word, from that one, one word, and they wanna really, really, really believe everything's good.

[00:21:17] Lisa Maria Tartaglia: So I don't think it's all medicine is, you know, flawed or broken. I don't want you to sound like you know me to sound like I'm very negative, but I do see it like every day the flaws. And that's why when I was trying to figure out with COVID. How do I reinvent myself? I'm burnout. I'm tired. I, I can't go on like this.

[00:21:35] Lisa Maria Tartaglia: And we actually, my brother's, father-in-law was passing away in New Jersey and I was helping them via Zoom and stuff, and he's the one that suggested, he said, this is, this is like a consulting service. You're telling me more than the hospice, any of the doctors. This you need to. Take your show on the road.

[00:21:52] Lisa Maria Tartaglia: And that's how I've developed my business. And it's kind of, in a way, some days I feel sad for the patients that I, they have to get to [00:22:00] me, for, for honesty or for completeness. But then I'm also relieved for the patients that I do get to touch because I do help them significantly. But there's a lot more out there that I'm not able to touch, you know?

[00:22:11] Lisa Maria Tartaglia: 'cause there's just too many out there, you know, that are sick.

[00:22:15] Dr. Katie Deming MD: so, so tell us. Like, tell us what, what do you do when you're called in for, you know, a, a patient? Like what is, what is the type of person who would call you in and, what does that look like when you work with them?

[00:22:30] Lisa Maria Tartaglia: Sure, sure, sure. So a lot of my patients come to me via word of mouth and um, some of them come, I would say 50% come from case management of the hospital hospitals, because a lot of times patients are coming in and out of the hospital. And oftentimes they get tagged with a, case manager to try to prevent a rehospitalization.

[00:22:49] Lisa Maria Tartaglia: And I work a lot with private case managers that know that I'm really, you know, strong and I can create a good picture and good, a good relationship with the patient and try to [00:23:00] prevent, um, further hospitalizations. And then there's another group of patients that come to me from, caregiver support groups like my dementia patients.

[00:23:08] Lisa Maria Tartaglia: That's how I receive a lot of them, like. By word of mouth from family members. What I basically do is I. Go into the patient's home. Initially, I do a phone consult because I wanna make sure, patients are comfortable with me, the family's comfortable with me, and that I'm not wasting anyone's time because there are some people that they're just not ready.

[00:23:28] Lisa Maria Tartaglia: And that is a okay, you know, I never wanna force, my business is name, name is Promesa, which means promise and Italian. So my promise is to be helpful. And if I'm not gonna. Be helpful. That is okay. And, um, we don't go into a relationship or, a consulting, um, relationship at that point. Most of my patients will sign contracts with me and basically I follow my patients.

[00:23:50] Lisa Maria Tartaglia: I go out and do an initial, comprehensive physical exam. Some of it can be done via Zoom or, or I use, um, a different platform with my electronic records. [00:24:00] I can do telemedicine, and or if they're local, I prefer to meet the patient in person. Uh, what I found when I've started just doing straight telemedicine, a lot of seniors get really frustrated with technology and, uh, if they are seniors and also sick and they're by themselves and they don't have familial support, it's better for me to do it in person.

[00:24:21] Lisa Maria Tartaglia: Um, when I go into their house in person, I look at their whole. Set up of how their home is set up. Um, what, what's, what's their goals of care? They fill out a form before I go out there and like, what are their goals? And their goals can be. Go to graduation. I wanna go on a cruise. You know, I wanna, I wanna go to Italy one last time.

[00:24:39] Lisa Maria Tartaglia: I wanna be able to run again. I wanna swim in the pool, you know, and we work on how we're gonna achieve those goals based on symptom management. The first thing I always do when I'm in with the family is look at all their medications because, I'm not sure. How it is in the west, but on the east side where we, we are where I am, because there's so [00:25:00] many snowbirds, they have multiple doctors in multiple areas of the country.

[00:25:04] Lisa Maria Tartaglia: So a lot of times medicines get wonky and it could just be as simple of me de de-prescribing several medications and make a world of difference in a patient's life. and then I look at, once I de-prescribe, looking at that, if there's any true symptoms that really need to be managed, that are acutely affecting the patient.

[00:25:21] Lisa Maria Tartaglia: I never do a lot in one visit because I wanna just see if one, what one change makes before I go ahead and make the second. Now, there are some times where it's every 24 hours making changes if someone is acutely symptomatic, but most of my patients come on relatively stable. And it's a matter of getting the right people in the house to help them, caregivers, nurses to deliver medications.

[00:25:45] Lisa Maria Tartaglia: I work with different pharmacies to bubble pack medicine, so it's less confusing for dementia patients. And then basically, I, I see my patients some, every other week, some weekly, most of my patients are monthly visits, and then I'm a phone call [00:26:00] away. to consult with family whenever there's a change in status, then I will fit them into my schedule.

[00:26:05] Lisa Maria Tartaglia: I can do telephonically and I just guide them. So I'm like a coach. Um, I call myself. A life coach, but a lot of my colleagues and friends call me a death coach because I do prepare people towards the end of their life. But I also wanna get in very early on as to what their goals are and, and. You know, we don't have to be all gloom and doom about end of life until the end of life really comes.

[00:26:32] Lisa Maria Tartaglia: We can just talk about, you know, what they did in the past. We do a lot of life review. I get to know the patient's families,and I get to help them with a lot of their psychosocial, aspects too. And I will bring in, you know, psychology if they need to talk to somebody. Grief counselors, if they've are a bereaved spouse, that now is sick again.

[00:26:53] Lisa Maria Tartaglia: You know? And that's, that's pretty much, what I do. I also spend a lot of time in the community [00:27:00] speaking at like caregiver support groups, going into a independent living facilities talking about symptom management, dementia, cancer, any of these kind of, um, topics that people wanna talk about, but they're afraid to ask.

[00:27:14] Dr. Katie Deming MD: I love that and I love that you're doing this consulting work in the way that you are

[00:27:18] Lisa Maria Tartaglia: Mm-hmm.

[00:27:19] Dr. Katie Deming MD: I think that. Having a physician who can really explain kind of the whole picture and then also there to just meet them where they are and help them with what I mean, honestly, every person needs this.

[00:27:35] Dr. Katie Deming MD: Everyone needs this. But it's amazing that this is available like that pa, people who qualify for palliative care have this as an option. And so, I, I, I love what you do and I mean, that's why we're having this conversation is that I'm a big proponent of these kinds of services and making sure people understand that they're there.

[00:27:57] Dr. Katie Deming MD: And then also the big piece, you know, [00:28:00] that people don't wanna talk about, but I wanna talk about here is, is hospice, right? And it is that, you know, the one that's scary, like, everyone hears this word and they're like, don't bring up the word. Like, don't, you know, don't say it. For me, again, I was always in my practice like.

[00:28:16] Dr. Katie Deming MD: If we know that you qualify bringing them in, it doesn't mean like they take over everything. It just means if you know that you're not pursuing active treatment and that you qualify for hospice, you qualify for a lot of services. There's a lot of things in there that are value. And then like you said, families then can be prepared and people can get their goals like met before they go.

[00:28:42] Dr. Katie Deming MD: And so. Let's talk about that. Let's talk about hospice. Let's talk about like what qualifies someone for hospice, and then how do you view that in terms of the early, you know, early intervention and, and what is your recommendation there?

[00:28:56] Lisa Maria Tartaglia: Sure. So when a patient qualifies for [00:29:00] hospice, as I said before, it's usually a six month or less prognosis. So it's somebody with can you know, I can go through each diagnosis very briefly, but it's a cancer patient that has exhausted all treatments or has decided to stop treatments because the risk of the treatment is not worth the benefit.

[00:29:17] Lisa Maria Tartaglia: They call those types of patients. Qualify, for hospice. Then there are the patients that are oxygen dependent, chronic obstructive pulmonary disease patients. And these are these people that are just having a real hard time catching their breath and they get a lot of infections and they're going in and outta the hospice hospital.

[00:29:35] Lisa Maria Tartaglia: They qualify for hospice, um, congestive heart failure. Now that there's two different types of congestive heart failure. It's so different from when I start first started practicing over 20 years ago. patients do, do not need to be oxygen dependent. Um, they just, they do not have to have a certain injection fraction, which is, um.

[00:29:54] Lisa Maria Tartaglia: You know, what we used to utilize, it's, it's based on symptoms. If they've had a lot of hospitalizations, [00:30:00] if they're maxed out on their medications and still symptomatic, these patients, qualify, uh, for hospice care for dementia patients. They're more of, um, the patients that are really affected with their activities of daily living.

[00:30:13] Lisa Maria Tartaglia: They're having a lot of falls and a lot of infections, and they're not able to really make their needs known. a lot of them are mostly incontinent, but not everybody has to be completely incontinent. It's more that they can't really get their words out. They're having difficulty with their activities of daily living.

[00:30:29] Lisa Maria Tartaglia: And again, it's, it's always with every disease, it's infections and falls. So I always tell my nurses it's, I, I, I like to use everything with food. It's m and ms. It's, it's, mobility. So that's the m nutrition. How are they eating if they're losing a lot of weight, and then the mentality of their mental status is changing.

[00:30:47] Lisa Maria Tartaglia: These are big telltale signs that we're moving away from palliative and more towards end of life care. there's other diseases such as end stage liver disease and stage kidney disease. They're a little more specific like [00:31:00] that. There's lab values, but again, if they're being more, if they're more debilitated and those kind of things are in, in effect.

[00:31:07] Lisa Maria Tartaglia: That's when we start to look at, hospice services. There's other neurological illnesses like, a LS Parkinson's Disease. These patients, when they come on hospice really early, meaning just their, they're, they have less symptoms. They live a really long time because we're in there that every time, you know, there's a caregiver that's provided by hospice that's there. And they, they will, uh, help and see if the person is having trouble swallowing their food. And we make diet modifications. So we prevent a lot of, decline in them. So the way I approach, hospice in my practice, You know, not to regress, but my practice, I've, I've kind of am a lot like you, Katie.

[00:31:46] Lisa Maria Tartaglia: I'm a rebel. I opted out of big brother, meaning general medicine, controlling the way I practice medicine. So I'm a cash business, so I really can take all patients. And it's funny when you said, you know, everybody needs it. I'm [00:32:00] surprised when I get the widows that call me after their husband's died and they're like, we really, I need to see you a couple more times.

[00:32:04] Lisa Maria Tartaglia: And I then, you know, sign contract with them and help them. So I'm really a unique palliative, physician, but for my patients, when they're coming as a true palliative patient, I'm discussing hospice from day one. I tell them, you know, I was a former hospice medical director, and they're all like, you give morphine.

[00:32:23] Lisa Maria Tartaglia: Yes, I do. And I just wanna let you know, morphine doesn't kill, you know, and I start having, you know, and I am very jovial and joking and I tell them like, we're not gonna take things away. And then, because I'm very enmeshed in my community, I know what hospice is better suited for each patient. So what I would like to tell you and and your audience about is hospice is not.

[00:32:44] Lisa Maria Tartaglia: The medications. That's what everybody thinks. Like, oh, you give morphine, you're gonna give my mom or dad my loved one a shot and they're gonna die. No, that's not it. What hospice truly does is is a com. It's a comprehensive, interdisciplinary [00:33:00] team that comes out to your loved one's home. For one global fee that's reimbursed by Medicare regardless of insurance status.

[00:33:07] Lisa Maria Tartaglia: Hospice never turns a patient away whether you have insurance, if you're not a citizen. None of those things play into mind 'cause every hospice has, funding and payback and they get one global fee. That fee incorporates a, a certified nursing assistant that can come to your home a couple times a week and help bathe your loved one.

[00:33:26] Lisa Maria Tartaglia: They help change the linens, they help provide, um, meals for your loved one. Um, maybe heating things up then, Then there's a nurse. The nurse must visit by law. In Florida, it's every 14 days, but most every hospice, we want eyes on the patient at least every seven days. And some patients are seen every other day depending on how sick they are.

[00:33:49] Lisa Maria Tartaglia: So that's a nurse going in, filling a pill box, making sure your medications are really there and you're taking the right tablets at the right time, and they're ordering the medicines, all [00:34:00] medicines. Are covered by your terminal illness are covered by hospice. So some of these medications that, you know, you have to wait forever to get, you know, from a pharmacy because everything's on back order.

[00:34:12] Lisa Maria Tartaglia: Hospices have their own ho hospice pharmacy and they have their own formulary and they provide the medications for free. If your loved one has a wound care like wounds, a lot of times when we get less, uh, mobile and more debilitated and our nutritional status changes so poorly, we unfortunately have skin breakdowns.

[00:34:32] Lisa Maria Tartaglia: So our nurses also provide, skincare, and I have to tell you. My nurse, my hospice nurses are the best wound care nurses, hands down that I've ever worked with. They heal things that are just impossible, um, and they make a difference. The other thing about the nurses is they're, since they're in the house, so often they're able to ascertain like if mom or dad or your loved one could be having an infection.

[00:34:56] Lisa Maria Tartaglia: Um, so we're right on that to treat the infection, and that's where a lot of [00:35:00] times people don't believe. To be true, but hospice does treat infections. in addition to the medical team, you know, obviously there's a physician, there's always a team physician. Most hospices now also have a nurse practitioner that helps with certification process and acute symptomatology like symptom management.

[00:35:19] Lisa Maria Tartaglia: Also, we have a licensed clinical social worker that not only does mental health counseling for the patient and the family, but also prepares them with, you know, their wishes. What were their wishes? What, what do they wanna, what, what do they want their future to look like? they also plan funeral planning.

[00:35:37] Lisa Maria Tartaglia: We do like life review, hospices do life review. Some patients make books, some patients make CDs. Uh, they might leave fingerprints. Um, I've had patients that are young and just amazing and they'll write recipe books to their children. They'll have different notes for every year of their children's life till they're 18 of what they expect for them.

[00:35:59] Lisa Maria Tartaglia: It's [00:36:00] very beautiful. And then. There is a chaplain that's part of the team, and that chaplain is a non-denominational. And it's not about religiosity, it's about spirituality. And even if you're an agnostic and you don't wanna be spiritual, that's fine. They can sit, they can read with you, or they never come back, but by, by the guideline, they're able to come and see you once a month at minimum.

[00:36:23] Lisa Maria Tartaglia: And then hospices are loaded with volunteers. Why? Because so many people feel. Like when they finally reap the hospice benefit they wanna give back. They volunteer in thrift stores, they volunteer patients bedsides. Um, they volunteer cooking like in a hospice house. So that's really the benefit of hospice and.

[00:36:44] Lisa Maria Tartaglia: It's such a shame that, um, there's such a misnomer that it's all about like hospice coming in and taking things away. Unfortunately, the reason why that happens is a large percentage of hospice patients, get captured 72 hours [00:37:00] before passing. And that's what every hospice is fighting against, right? We wanna get patients in sooner so we have time to build relationships and, and create bonds and

[00:37:11] Lisa Maria Tartaglia: to have the, an alliance and have a partnership so then they feel comfortable with you and you're able to allow them to pass naturally. Um, but they, they're able to build a relationship and it's on their terms. And that's basically, hospice in a nutshell.

[00:37:26] Dr. Katie Deming MD: Yeah. Well, and you, the fact that you just went on, I don't know how many minutes that was of all the benefits of No, no, no. That, no, no, no. I, the fact that you went on for as long as you did of all the benefits of hospice is exactly why I'm always like, get them as early as you can because you can use them as little as you want, but at least they're in place and you have, there are all, like you just described, there are all these resources and because it's now.

[00:37:56] Dr. Katie Deming MD: Capped or I don't know what, what was the word that you described? It is like [00:38:00] basically you're not no longer being billed for all these different things. It's under one.

[00:38:04] Lisa Maria Tartaglia: One umbrella.

[00:38:05] Dr. Katie Deming MD: One umbrella that people get so much more service for what they were paying before, just tons. They're, they're gonna be paying less, they're gonna be taking the right things, not, you know, having someone come through and say, you actually don't probably need to take these medications and, and going through that.

[00:38:22] Dr. Katie Deming MD: But I, I do think this perception that people have is. If I'm going on hospice, that means it's over. Like I'm dying within a week. And like they're gonna take everything away and then they're gonna just push morphine. And I know just from, you know, I've been involved with hospice at multiple levels of my career.

[00:38:41] Dr. Katie Deming MD: You know, that's where I, that's the reason why I came into medicine was because volunteering at hospice and then I've spent time, you know, working with palliative care and hospice as a radiation oncologist and it for me. The, of course, there are times where there's not a fit, and this is what I would say is if, [00:39:00] if you ever have a team, no matter what service you're in, whether it's hospice or something else, you can always say like, oh, this nurse isn't a fit for me or whatever.

[00:39:08] Dr. Katie Deming MD: But. These services are so valuable and the people that actually use them and go in early, maybe when it seems almost even premature, are the ones who have that beautiful experience as opposed to if like it's just this last minute thing and you're rushing and then they get home and then they just die.

[00:39:28] Dr. Katie Deming MD: And it really, there you didn't reap the benefits of all of these services. It's a shame, like for me it feels like a shame. And so I. I'm so grateful to have you share this and actually hear my, have my audience here. You know, these are the benefits, these are the things. And also recognizing that it's not a perfect system.

[00:39:47] Dr. Katie Deming MD: And so these are people, right? And these are different systems, and sometimes maybe this hospice is not right for you. It may be that there's multiple hospices within your area, and like you were just saying how, you know, like what are the [00:40:00] right ones, you know, based on the person's needs. I guess that may be a question for you is how would someone go about.

[00:40:07] Dr. Katie Deming MD: Picking a hospice in their area, if they have multiple, like what is the way to, to learn about, you know, which ones provide the services that might be right for what you or your loved one needs.

[00:40:19] Lisa Maria Tartaglia: Right. Well, it's really good. after hospice, Hospice has taken a patient under care. There are surveys that go out to families, and those surveys are public. So it's really good to look at the surveys and read what, families have written. Now, obviously there's a lot of emotion related to end of life.

[00:40:37] Lisa Maria Tartaglia: so some of them you can just read through like, oh, maybe that could be just a troubled. You know, spouse or whatever, but you can get a good idea if you see a lot of the different surveys, you know, airing on that same side, that that might not be a good fit. But every hospice provides an information only. what I tell families is interview them. You're taking them under [00:41:00] service and you need to figure out if the fit is right. And if the fit is not right, you can change hospices. It happens. They don't like to do it, right? 'cause it's, let's face it, Katie, we're medicine. We know it's paperwork. Nobody wants to do it, but you can do it.

[00:41:14] Lisa Maria Tartaglia: And you can also revoke service. You can leave whenever you want. Like a lot of times hospices will say you cannot go to the hospital. Well. You really can go to the hospital and hospitalizations can be paid if they're not related to the terminal illness. Like at under, under a separate umbrella. But let's face it, like in medicine we're, we have so many and so many people in the kitchen trying to be chefs that we like to keep it simple, right?

[00:41:40] Lisa Maria Tartaglia: So we, we tell our patients, no, we don't want you going to the hospital 'cause it's a lot of paperwork, it's a lot of red tape. But you can, you can revoke, and you can, um, switch. providers. So what I would tell, uh, your audience is to just interview and then also ask your friends, like, there's always somebody, unfortunately in your community, in your church, [00:42:00] in, in, you know, uh, your yoga class that may have had an experience and they could tell you who, who they used, You know, it's, it's all based on your demographics. So for me, I'm spoiled because I'm practicing medicine in a community where I've worked for many years. So I know all the idiosyncrasies and I do, you know, handpick, and steer my patients to a hospice. But then I will have some of them say, well, they didn't like that, so then we just try another one.

[00:42:26] Lisa Maria Tartaglia: But I will tell you, your loved one will live longer on hospice. I see it all the time. I wish that there was more research studies, available for this because they just live longer and, healthier and more peacefully on hospice.

[00:42:40] Dr. Katie Deming MD: those surveys that you were describing, how would people find the surveys for the different hospices?

[00:42:45] Lisa Maria Tartaglia: It's usually, it has to be listed on their, on their website, like on the hospice website. Yeah.

[00:42:51] Dr. Katie Deming MD: Yeah. On their website. And then also, I always encourage people to ask your doctor, because you're just like you. You know the [00:43:00] idiosyncrasies of the different hospices in your area. That same thing happens in every area. And so asking your doctor, is there a hospice that they feel like would be a better fit for them?

[00:43:11] Dr. Katie Deming MD: Because they're gonna know the nuance. Of like, you know, this one, it's like, it's a business. These are businesses, these are organizations that have their own issues. And so understanding, you know, the local dynamics can be helpful. So, that is really helpful. And I'm wondering, you know, if there was one thing that.

[00:43:34] Dr. Katie Deming MD: Someone who is right now, like, you know, someone listening here who either themselves or their loved one is really challenged by, you know, symptoms. Maybe they're not sure, like, they're like, I don't know if I meet, you know, criteria for this or palliative care. What is the best first step for someone to find out about, you know, what they would qualify for either palliative care or hospice?

[00:43:59] Dr. Katie Deming MD: [00:44:00] How would you guide them?

[00:44:02] Lisa Maria Tartaglia: There are different, websites that sh that, I, you know, I don't know off the top of my head, but honestly, every hospice has the criteria. So if you're, like, for me, where I live, there's a lot of national chains. That are, you know, that have local, partnerships. They all, every hospice should have the criteria listed and it will tell you, you know, if you're experiencing it's, it'll be very much in layman's terms, but there are, there are, it's, you know, there are that ac there guidelines for every hospital, hospice nationwide.

[00:44:35] Lisa Maria Tartaglia: And they're very readily available on, on Google. You could just Google them, but even your local hospice should have them in, in their website. so that will help. And then the other thing is with palliative care, a lot of times palliative care is linked to a hospice. So they might come on as a palliative consult, and then we'll have like, let's say a nurse practitioner come in [00:45:00] and, do a goals of care with a family, try to meet the family where they're at.

[00:45:04] Lisa Maria Tartaglia: They will then tell them like, Hey, you know, your loved one really does qualify. For pal, the palliative arm versus the hospice arm, and they'll go through the benefits. So the hospices have no trouble coming out and doing information only. Uh, your physician should also know, you know, what your qualifications are based on how many hospitalizations you've had, infections and things of that nature.

[00:45:29] Lisa Maria Tartaglia: So they should also be able to, um, help you.

[00:45:32] Dr. Katie Deming MD: and that's what I was gonna say too, is that you know, really asking your physician like, is there. I, is there someone that you can talk to about palliative care and, and whether or not you would benefit from these services? You know, and I think oftentimes the physicians are so busy that even though this would help, because it actually helps offload some of the care so that they can have help from this other, you know, specialist.

[00:45:58] Dr. Katie Deming MD: But I think that sometimes [00:46:00] people just don't have time and then they forget, you know, these are the things that are available. So asking your physician, I for sure would also recommend, but. Lisa, it's been so nice having you here talk. I know I wanna bring you back to talk about grief because I, I think that was originally the reason I reached out.

[00:46:17] Dr. Katie Deming MD: I was like, I would love to have a conversation with you about that. But I think this was so important for people to understand, like, what is palliative care? What is the difference between palliative care and hospice, and how can we utilize the value that is available for these services? So can you tell people.

[00:46:34] Dr. Katie Deming MD: Where they can find you and also where do you, you practice in Florida, but also you del do telemedicine, so what other states are you available in for telemedicine?

[00:46:44] Lisa Maria Tartaglia: Okay, I'm licensed in, North Carolina, South Carolina, and Georgia. And I practice also, you know, licensed in Florida. So I'm happy to help. Any one of your, uh, audience members? My website is, my promesa.com. That's, [00:47:00] that's, uh, how you can get ahold of me and through, um, the website, it has my office number and I link up and every patient I do a consult with, like I said earlier, just to make sure that we're all on the same page and, you know, we'd be happy to help, uh, any of your audience members in any way.

[00:47:17] Lisa Maria Tartaglia: Shape or form. Um, my email's also there, so even if you're not from the state, you know, that I can practice in. I'm happy to guide you because I know a lot. Um, you know, I've been board certified in this for many years and I've worked in every facet of hospice, so I, I know all the idiosyncrasies and how to, you know, how to get your loved one on service and the right service.

[00:47:38] Dr. Katie Deming MD: I love it. Well, we will link your website, in the show notes so people will have access to that. But thank you so much for coming on and sharing your wisdom. I look forward to having you back.

[00:47:49] Lisa Maria Tartaglia: Okay. Thank you, Katie.