Live Facilitation: Tuesday, June 27, 2017 from 1:00pm EST to 2:00pm EST
Topic: Palliative Management of Advanced Liver Disease
Facilitator: Christopher Woodrell, MD
Assistant Professor, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
Staff Physician, Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY
Location: This Discussion Forum may be accessed through the End of Life course online at www.gerischolars.org or directly at: http://www.gerischolars.org/mod/hsuforum/PalMedESLD
Dr. Woodrell will facilitate a participant-driven discussion based on the following introduction and case.
Please read the following introduction and case prior to the Discussion Forum.
You will be able to ask questions and share your thoughts with Dr. Woodrell and other colleagues participating in the Discussion Forum.
Introduction: More than five million Americans are estimated to have chronic liver disease, which if untreated, will lead to cirrhosis and end-stage liver disease (ESLD), the twelfth leading cause of death in the United States. The most common causes are Hepatitis C Virus and Alcoholic Liver Disease. The incidence of non-alcoholic steatohepatitis (NASH) cirrhosis is also rising, in parallel with the obesity epidemic. The only cure for ESLD is transplantation, and while the number of patients on the waiting list for a transplant continues to rise, the number of organs available remains relatively flat. People with ESLD suffer from heavy symptom burden that is unique to liver disease, and the course is fraught with distressing uncertainty around prognosis.
Consider the following case: Mrs. H is a 76 year-old woman who you have taken care of for many years. She has a history of Hepatitis C and was successfully treated with direct-acting anti-virals a year and a half ago; however, she has recently been noted on imaging to have a cirrhotic liver. She has had no prior decompensating episodes until recently when she developed new onset ascites. She is in a great deal of pain and is distressed by her situation when she presents to your office. She asks you, “What is going on? What are we going to do?”
Live facilitation will take place between 1:00PM to 2:00PM EST. The Discussion Forum will remain open for all participants afterwards.
Dr. Woodrell received his medical degree from the Icahn School of Medicine at Mount Sinai and trained at the Mount Sinai Hospital as a house staff officer in internal medicine. He continued his training at Mount Sinai as a fellow in hospice and palliative medicine, and is board certified in Internal Medicine and Hospice and Palliative Medicine. He is an Assistant Professor in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine and Staff Physician at the Geriatric Research, Education and Clinical Center at the James J. Peters Veterans Affairs Medical Center in Bronx, NY. Dr. Woodrell is a clinical investigator whose work is dedicated to improving the care of seriously ill patients with liver disease and their families. His research goal is to create and implement palliative care programs tailored to the specific needs of people facing advanced liver disease and liver cancer.
Dr. Woodrell completed undergraduate training in biochemistry at Swarthmore College. He hails from Southern California and before medical school had a career as a ballet and modern dancer.
For any questions regarding this forum, please contact Ms. Eugenia Dorisca at Eugenia.Dorisca@va.gov
Geriatric Scholars Learning Community Team