Thursday, 21 March 2019

Do we age with our Music?



In 1967, I'd joined the Army that May and remember listening when Radio One came on air for the first time. 7 am I think it was, but us soldiers had done a days work by then :-) We'd had Radio Caroline since 1964 but I was more into classical music at that time as I'd played violin in the school orchestra. But for a few years, I'd never tune to another station, Radio One would live forever!

As the years went by I found the music I loved was decreasing on that station, and I eventually migrated, along with the music, to Radio Two. I was happy again, with stuff that I recognised, and even though I tried to 'modernise' I just couldn't like much of the new stuff.
Well, I suppose inevitably, Radio Two started to go downhill for me too, and when I moved to Thailand four years ago I found where all my favourites had gone. All the music I like from the 60s/70s had moved to the night shift in the UK, between about 1am and 5 am, which was great because I got to listen at 8 am to 1 pm here in Bangkok.

I flicked back to Radio One the other day; do people really listen to that stuff? Sounded like the food blender with metal in! I guess it's an age thing.
Thanks to the Internet we can listen to anything from around the world now. Do you know any stations that play a good selection of 60s 70s even 80s music, without a DJ who wants to ramble on for 10 minutes between tracks? Tell me, please! Or even a good 'chat show' where the common man comes on and debates anything/everything, like the James Whale Show?



Saturday, 9 March 2019

They won't remember everything you said, but they will remember how you made them feel.

Where do we go when we die?


 One day you’ll be reading this, and I’ll be dead! It might be this edition, fresh off the press, very unexpected; I hope not! More likely, you’ve found a tatty old copy of Expat Life Thailand in the dusty magazine rack of a derelict laundry in Sala Daeng. You’re there, hiding from the chaos outside! The shouting and screaming of hundreds running swiftly through narrow streets care nothing of who they might target next! The police and soldiers stand by powerless as the onslaught spreads; it’s a free for all! All thoughts of tomorrow are gone, today’s all that matters! Your heart’s pounding, body clammy, mind’s racing. How did I get here? What could I have done differently?

It'll be too late soon to have a voice; the dead are silent, everything they ever said distorted and forgotten, leaving others with just, 'how you made them feel.' The only things left, films, sound recordings or scripts like this, unchanging, frozen for eternity, just evidence that you were here once!

I've experienced many funerals and can't remember one which wasn't farcical in some way. At my father's, his then current partner, dear old Ivy, sat near the back of the church out of respect for my mother and her children. We, in turn, felt so sorry for her obvious grief that we sat in the remaining seats behind. The priest had to shout from the altar, his voice echoing over thirty rows of empty pews between him and the rest of us! We didn’t know what my father would have wanted, so there we all were, actors in a B movie comedy! 

I dislike those European funerals with the big ugly black limos, the distraught family, some doing their best to look distraught, many just wanting to be seen to be there, to 'pay their last respects.' I'm not even sure what that means! If you want to 'pay your respects,' do it when I'm alive so I can have the pleasure of that meeting! Visit while you can, I sincerely don't want your company when I'm dead when it's all one-way talk. If you don't like me, let's make friends. Know that sometimes, it’s too late! Don't whisper to my spirit after your free tea and sandwiches; you'll be talking to yourself. Don't wait to read my obituary, it’ll probably never be written! Learn about me while I’m alive, speak now, hear my story and tell me yours; I'd like that! 

Why does it cost six times that of a business class ticket to fly a dead body to another country, when you’re not even eating from the flight menu? If I die overseas, that's where I want to remain. I don't want a funeral, though I know my body must be disposed of, I want it all done with minimum fuss. Buddhists do it best, don’t you think? Avoid flying in from anywhere to see me dead; I'd rather you gave the fare to someone in need. Ashes? Sure, you can have some, but don't talk to them, it's not me! I'm here now. Talk to me!

When my father was alive I didn't make much effort at keeping in touch; I had a young family, it could always wait until another day. What I'd give to talk now, tell him where I've been and what I've done. I'd hug him for the first time! When he died, I felt a part of me went with him; that way I still feel close. When my mother went, it laid ruin to what was left; all sleeping demons arriving at once!

So, where do I believe we go when we die? We tell our children, "You go back to where you were before you were a baby." I love that! After nearly 70 years, dipping in and out of religion, searching for the truth, I finally found what sits comfortably, and it's simple... 
I don't know, and nobody else does; Hindus, Jews, Catholics, Muslims, Atheists, say your piece, but if you claim to know, then you’re in immediate conflict with billions of others. Why should you be right and they wrong?
There are roughly 4,200 organised religions in the world. I say ‘organised’ to indicate they probably have a leader, a headquarters and a bank account, but some faiths may only have one person with their own set of unique beliefs; like me!

Look at the top five:
Christianity                             2.2 billion
Islam                                      1.5 billion
Secular/Agnostic/Atheist        1.2 billion
Hinduism                                1.1 billion
Buddhism                               535 million

When a member of one of those dies, they all have very different scenarios in ‘what happens next,’ and all deal with it in very different ways. So, where my open spiritual mind says and feels that there could indeed be a ‘God Almighty’ would that God really have 4,200 different versions of ‘what happens next?’ Or do we desperately research all 4,200 to find which one suits us best? I know that random reincarnation wouldn’t suit me at all, coming back in the lifeform of anything from a goat to a jellyfish, a pigeon to a tuna, all have obvious downsides; and I can think of worse! Having started out as Catholic and experiencing up to 20 other religions over 60 years, I’ve now parked my soul in the Buddhist bay.

My belief is that those who believe there’s nothing after death are just as wrong as those who believe there’s something, because the truth is, we don't know, and that gives me comfort. It means we enter the final journey knowing there might be nothing, but also that there might be something; an element of hope. After all, if there is some higher being, an Almighty God, they will surely understand why we mortals might, looking at the evidence, have doubts about the 'masterplan.'

Yes, the dust from my body will float along with yours, journeying for eternity throughout the cosmos, scattering over millions of light years. The energy that makes life possible will dissipate, just as candlelight does when the wind gusts. As to what happens then, I don’t know; you don’t know, nobody knows! 
So, go now! Grab your weapon, reload and take your chance amongst the bellowing mob outside. Revel and rejoice in the festival of Songkran, where you can die safely a thousand times. I’m gone, but your voice still matters. Talk, shout, scream with joy! 
I’m where we go when we die! 

Sunday, 24 February 2019

How to recognise when someone is dying

The dying process usually begins well before death actually occurs, and understanding this process can sometimes help you recognize when your loved one is dying. There are changes that take place physically, behaviorally, and psychologically in the journey towards death, that are signs that the end of life may be nearing.
Death is a personal journey which each individual approaches in their own unique way. Nothing is concrete, and nothing is set in stone. There are many paths one can take on this journey but all lead to the same destination. What happens in the journey of dying, beginning one to three months prior to death, during the last two weeks before death, and during the last few days of life? In this continuum, how can you know when your loved one is dying?



The Dying Process 

As a person comes close to death, the dying process begins; a journey from the known life of this world to the unknown of what lies ahead. As this process begins, a person starts on a mental path of discovery, comprehending that death will indeed occur and believing in their own mortality. The journey ultimately leads to the physical departure from the body.
There are milestones along this journey. Because everyone experiences death in their own unique way, not everyone will stop at each milestone. Some may hit only a few while another may stop at each one, taking their time along the way. Some may take months to reach their destination, others will take only days. We will discuss what has been found through research to be the journey most take, always keeping in mind that the journey is subject to the individual traveler.
The Journey Begins: One to Three Months Prior to Death 
The dying process starts to be recognizable for many people in the period between a month and three months prior to death. As we discuss these changes, we may use the words 'he" or "she," but the process is fairly similar regardless of gender. There are some differences.
Behavioral and Psychological Changes: As a person begins to accept their mortality and realizes that death is approaching, they may begin to withdraw from their surroundings. They are beginning the process of separating from the world and those in it. Your loved one may decline visits from friends, neighbors, and even family members. When she does accept visitors, she may be difficult to interact and care for. This is a time when a person begins to contemplate their life and revisit old memories. In evaluating her life, she may be sorting through any regrets. She may also undertake the five tasks of dying.
Physical Changes: The dying person may experience reduced appetite and weight loss as the body begins to slow down. The body doesn't need the energy from food that it once did. The dying person may be sleeping more now and not engage in activities they once enjoyed. They no longer need food nourishment. The body does a wonderful thing during this time as altered body chemistry produces a mild sense of euphoria. They are neither hungry nor thirsty and are not suffering in any way by not eating. It is an expected part of the journey they have begun.

One to Two Weeks Prior to Death 

The dying process often accelerates in the last one to two weeks of life and can be frightening for families. The mental changes, especially, can be disturbing to family members. At this point in the journey, it is not advisable to "correct" your loved one if she tells you something that doesn't make sense. Gently listen, and support her in her thoughts. If she claims to see loved ones who have died, simply let her tell you. We really don't have a way to know if these are hallucinations, or if our loved ones have seen something we cannot see. Simply love her.
Mental Changes: This is the time during the journey that one begins to sleep most of the time. Disorientation is common and altered senses of perception can be expected. One may experience delusions, such as fearing hidden enemies or feeling invincible.
The dying person may also experience hallucinations, sometimes seeing or speaking to people who aren't there. Often times these are people who have already died. Some may see this as the veil being lifted between this life and the next. The person may pick at their sheets and clothing in a state of agitation. Movements and actions may seem aimless and make no sense to others. They are moving further away from life on this earth.
Physical Changes: The body is having a more difficult time maintaining itself, and your loved one may need help with just about any form of activity. She may have trouble swallowing medications or may refuse to take the medications she has been prescribed. If she has been using pills for pain, she may need liquid morphine at this time. There are signs that the body may show during this time:
  • The body temperature lowers by a degree or more.
  • The blood pressure lowers.
  • The pulse becomes irregular and may slow down or speed up.
  • There is increased perspiration.
  • Skin color changes as circulation is diminished. This is often more noticeable on the lips and nail beds as they become pale and bluish.
  • Breathing changes occur, often becoming more rapid and labored. Congestion may also occur causing a rattling sound and cough.
  • Speaking decreases and eventually stops altogether.
  • Periods of quietness may be interrupted by sudden movements of a person's arms or legs.

Journey's End: A Couple of Days to Hours Prior to Death 

The last couple of days prior to death can sometimes surprise family members. Your loved one may have a surge of energy as she gets closer to death. She may want to get out of bed, talk to loved ones, or ask for food after days of no appetite. Some loved ones take this increase in energy to be a sign the person is getting better, and it can be very painful when the energy leaves. Know that this is common, and is usually a sign that a person is moving towards death, rather than away.  This surge of energy may be quite a bit less noticeable but is usually used as a dying person's final physical expression before moving on.
The surge of energy is usually short, and the previous signs become more pronounced as death approaches. Breathing becomes more irregular and often slower. Cheyne-Stokes breathing, rapid breaths followed by periods of no breathing at all, may occur. Congestion in the airway can increase causing loud, rattled breathing. Again, this change in breathing can be very uncomfortable for loved ones but does not appear to be unpleasant for the person who is dying.
Hands and feet may become blotchy and purplish (mottled). This mottling may slowly work its way up the arms and legs. Lips and nail beds are bluish or purple and lips may droop. The person usually becomes unresponsive and may have their eyes open or semi-open but not seeing their surroundings. It is widely believed that hearing is the last sense to go so it is recommended that loved ones sit with and talk to the dying loved one during this time.
Eventually, breathing will cease altogether and the heart stops. Death has occurred.

Many people wonder if they will recognize if a loved one is dying, and there are often signs which begin a month to three months prior to death. Understanding these signs may not only help you prepare for your loved one's death but may bring you comfort as you face these physical and mental changes. If your loved one is on hospice, your hospice nurse, social worker, or clergy can help you recognize and understand some of the changes, and help you know what will help you support your dying loved one as much as possible.


Sunday, 10 February 2019

What if PSA returns after surgery!


The return of PSA is a possibility that strikes terror in the heart of every radical prostatectomy patient; in fact, for many men, the dreaded follow-up PSA tests after surgery are almost worse than having the operation itself. What will you do if your PSA is no longer undetectable? The good news is, you may not need to do anything for years.

Does the man have a local recurrence of cancer that would respond to radiation, or does this represent micrometastases to lymph nodes and bone? Until now, there has been no way to tell.

In a landmark paper -- the largest, most complete study of the return of PSA after radical prostatectomy -- Hopkins doctors have developed guidelines to help patients and doctors know what to do if PSA comes back. Their remarkable effort -- an elegantly simple chart that accurately predicts a man's risk of developing metastatic cancer -- is the post-operative equivalent of the "Partin tables," developed by urologist Alan W. Partin, M.D., and urologist-in-chief Patrick C. Walsh, M.D. Like those now-indispensable tables, this chart has the potential to revolutionize the way doctors and patients make decisions about what to do next.

"PSA is very sensitive in detecting any recurrence of cancer. That's because only prostate cells make PSA -- so if it goes up after a radical prostatectomy, it means prostate cells are still present somewhere. For all intents and purposes, it means that a few cells escaped the prostate before it was removed, and now have grown to the point where they're producing enough PSA to be detected," explains Walsh.

"Fortunately, for most men with organ-confined cancer, this never happens. However, for men who had more advanced disease at the time of surgery, the return of PSA is extremely frightening." Walsh originated this study to fill what he describes as a "large knowledge gap" for patients and doctors.
  • "The first thing many patients want to know is, how long are they going to live?
  • And the first thing many doctors want to know is, when should they begin treatment, and how should they treat these patients?
  • Does the man have a local recurrence of cancer that would respond to radiation, or does this represent micrometastases to lymph nodes and bone?"
Until now, there has been no way to tell. The study, published in the Journal of the American Medical Association, is based on 10,000 patient-years of follow-up data. Between 1982 and 1997, nearly 2,000 men underwent a radical prostatectomy at Johns Hopkins. Of these, 315 men developed an elevated PSA (defined as being higher than 0.2 nanograms/milliliter). Eleven of these men opted for early hormone therapy, and were not included in the study. The remaining 304 men were followed carefully.

On average, it took eight years from the time a man's PSA first went up until he developed metastatic disease -- which suggests that there is no need to panic at the first sign of a rise in PSA.

WHAT THE NUMBERS MEAN
If you have a Gleason score of 5-7
Your PSA increased more than two years after surgery
AND your PSA doubling time was greater than 10 months:
Your chance of not developing metastasis(having a bone positive scan) in:
    Three years:  95 percent
    Five years:     86 percent
    Seven years:  82 percent
OR your PSA doubling time was less than 10 months:
Your chance of not developing metastasis in:
    Three years:  82 percent
    Five years:     69 percent
    Seven years:  60 percent
OR your time to first PSA recurrence was less than two years:
AND your PSA doubling time was greater than 10 months:

Your chance of not developing metastasis in:
    Three years:  79 percent
    Five years:     76 percent
    Seven years:  59 percent
OR your PSA doubling time was less than 10 months:

Your chance of not developing metastasis in:
    Three years:  81 percent
    Five years:     35 percent
    Seven years:  15 percent
If you have a Gleason score of 8-10
AND your time to first PSA recurrence was greater than two years:

Your chance of not developing metastasis in:
    Three years:  77 percent
    Five years:     60 percent
    Seven years:  47 percent
OR your time to first PSA recurrence was less than two years:

Your chance of not developing metastasis in:
    Three years:  53 percent
    Five years:     31 percent
    Seven years:  21 percent



"We set out to ask a few questions, says Walsh: "Could we predict how long it would take for patients who had metastases to show them on a bone scan, and then once that happened, how long would they live? The news is actually quite good: Most patients do very well for a long period of time". On average, it took eight years from the time a man's PSA first went up until he developed metastatic disease -- which suggests, Walsh says, that "there is no need to panic" at the first sign of a rise in PSA. Even after developing metastatic cancer (detected by bone scans and other imaging techniques), men still lived an average of five years -- and if the metastases showed up more than seven years after surgery, men had a seventy percent chance of being alive seven years later.
"When men see their PSA levels rise again, they think that means the cancer is back and they need to get treated right away," says oncologist Mario Eisenberger, M.D., a co-author of the study. "But men often live for years without having the cancer spread. This information will better equip doctors and their patients to decide what treatment -- if any -- is most appropriate."

This interval between the reappearance of PSA and the first sign of advanced disease can be predicted, the Hopkins researchers found, using three pieces of information:
  • The Gleason score of the pathologic specimen (the removed prostate, evaluated by a pathologist after surgery). Is it Gleason 7 or lower, or Gleason 8 or greater.
  • The time it takes for PSA to come back. Is it less than two years after surgery, or greater? And,
  • How rapidly is the PSA level doubling? Is it greater or less than 10 months?
Using these criteria, men and their doctors can pinpoint the likelihood of developing metastatic disease. For example: If a man has Gleason 7 disease, has his first PSA recurrence more than two years after surgery, and has a PSA doubling time longer than 10 months, his likelihood of being, free of metastasis at seven years is 82 percent. Conversely, if a man has Gleason 7 disease, but his PSA goes up within two years of surgery, and the time it takes PSA to double is less than 10 months, his likelihood of being metastasis-free at seven years is 15 percent.
"So the first thing these tables can do is reassure the many patients who are going to have a long-term, symptom-free, metastasis-free interval, that close observation is all that's really necessary," says Walsh. On the other hand, says urologist Alan W. Partin, M.D., Ph.D., co-author of the study: "If their chances of progressing rapidly are high, they may wish to start hormonal therapy earlier or get involved in an experimental trial" of more aggressive treatment. "These tables are going to help men who are at low risk and help men at high risk make a more educated decision. We hope it will also decrease the anxiety for some of them." The tables will also provide invaluable baseline data for future drug research, adds Partin. "Until now, it's been difficult to know if a drug was helping someone because you couldn't be sure what the disease would have done on its own. Now, researchers can compare their treatment groups with our study group and tell if their treatment is improving survival."

PSA Anxiety:

The Downside of Ultra- Sensitive Tests
   You've had the radical prostatectomy, but deep down, you're terrified that it didn't work. So here you are, a grown man, living in fear of a simple blood test, scared to death that the PSA- an enzyme made only by prostate cells, but all of your prostate cells are supposed to be gone -- will come back. Six months ago, the number was 0.01. This time, it was 0.02.

You have PSA anxiety. You are not alone.

This is the bane of the hypersensitive PSA test: Sometimes, there is such a thing as too much information. Daniel W Chan, Ph.D., is professor of pathology, oncology, urology and radiology, and Director of Clinical Chemistry at Hopkins. He is also an internationally recognized authority on biochemical tumor markers such as PSA, and on immunoassay tests such as the PSA test. This is some of what he has to say on the subject of PSA anxiety:

The only thing that really matters, he says, is: "At what PSA levels does the concentration indicate that the patient has had a recurrence of cancer?" For Chan, and the scientists and physicians at Hopkins, the number to take seriously is 0.2 nanograms/milliliter. "That's something we call biochemical recurrence. But even this doesn't mean that a man has symptoms yet. People need to understand that it might take months or even years before there is any clinical physical evidence."

On a technical level, in the laboratory, Chan trusts the sensitivity of assays down to 0. 1, or slightly less than that. "You cannot reliably detect such a small amount as 0.01," he explains. "From day to day, the results could vary -- it could be 0.03, or maybe even 0.05" -- and these "analytical" variations may not mean a thing. "It's important that we don't assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it's less than 0. 1, we assume it's the same as nondetectable, or zero." 

 FURTHER READING

Pound, CP; Partin, AW; Einsenberger, MA;
Chan, DW; Pearson, JD; and Walsh,PC.
"New Method to Assess Risk of Advanced 
Cancer After Prostate Removal," Journal of the 
American Medical Association,
 Vol.281,
pp.1591-1597.

Shorter Duration of Radiation Safe in Treating Prostate Cancer



This study showed that stereotactic body radiotherapy reduced the duration of treatment from 45 days to 4 to 5 days with no evidence of causing worse toxicity in the long run.




Men with low or intermediate-risk prostate cancer can safely undergo higher doses of radiation over a significantly shorter period of time and still have the same, successful outcomes as from a much longer course of treatment, according to researchers.

 
The study showed that this type of radiation - stereotactic body radiotherapy - is a form of external beam radiation therapy, which reduces the duration of treatment from 45 days to four to five days with no evidence of causing worse toxicity in the long run. 


"Most men with low or intermediate-risk prostate cancer undergo conventional radiation, which requires them to come in daily for treatment and takes an average of nine weeks to complete," said lead author Amar Kishan, Assistant Professor at University of California, Los Angeles, in the US. 
"With the improvements being made to modern technology, we have found that using stereotactic body radiotherapy, which has a higher dose of radiation, can safely and effectively be done in a much shorter timeframe without additional toxicity or compromising any chance of a cure," said Kishan.
For the study, the team included 2,142 men with low or intermediate-risk prostate cancer who were treated with stereotactic body radiotherapy. They were followed for a median of 6.9 years.
Nearly, 53 per cent men had low-risk disease, 32 per cent had less aggressive intermediate-risk disease and 12 per cent had a more aggressive form of intermediate-risk disease.

In addition, the recurrence rate for men with low-risk disease was 4.5 per cent, 8.6 per cent for the less aggressive intermediate-risk, and 14.9 per cent for the more aggressive intermediate-risk group, findings published in the journal JAMA Network Open showed.

Overall, the recurrence rate for intermediate-risk disease was 10.2 per cent.

These are essentially identical to rates following more conventional forms of radiation, which are about 4-5 per cent for low-risk disease and 10 per cent to 15 per cent for intermediate-risk disease.

This method is both safe and effective and could be a viable treatment option for men with low and intermediate-risk of prostate cancer, the study suggested.

Friday, 11 January 2019

A page from the 'Book of Life'

No photo description available.

By my good friend, Susan Dustin

What a little contrast brings

Yesterday was my first day in 2019 of returning to walk with those in end of life. Standing outside of the hospital I lay my empty hands in front of my deliberately open heart and readied myself to receive and work with whatever would be presented to me. I prayed to offer those I encountered an empathetic grace-filled dignity even though I was feeling below par. 

People often comment to me that my walking with the dying is a laudable sacrificial endeavor. There may be aspects that are extremely emotionally taxing. Some situations also stretch my patience and ability to embrace others without bias. Occasionally there are passages so sacred that my failure to render them through any good account leaves me feeling isolated in the experience. Yet, even within my places of lack, great love and joy resound so profoundly that I am often transported into the divine. I am greatly enriched because I get to care for others in deep and intimate ways. The dying, through what great loss so clearly offers, often impart to me invaluable life perspectives. They, in all their broken frailty, teach me how to live fully! 
***
I suffer from reoccurring leptospirosis. The first year I contracted it, I had innumerable fevers, headaches, nausea, loss of appetite and hair, the threat of sight and organ damage, and deep exhaustion and depression plagued me. Throughout the past four years, it has randomly revisited for a month or two at a time. Because the symptoms are not as physical as the first bout, outside of extreme malaise, erratic thought and depression, I’m slow to realize that I am in the throes of it. Once I become aware, I fight furiously to heal and climb out of the pit in which it has cast me. It’s never easy. I eat well, rest when able and force myself to undertake exercises that produce but do not rob me of energy. I engage in positive, gentle thought as I bravely clear through a lot of emotional tears and frustrations. I do my best to keep humor and gratitude alive. Then usually, somewhere out of the blue, as mysteriously as it appeared and had me believing it would never leave, it disappears. Poof! 
***
Yesterday, several weeks into a Lepto Laze Phase, I was introduced to “Bertha”, a 66-year-old Thai hospital cleaner. Perched in her bed she was hooked up for her last round of a dozen chemo sessions for metastatic cancer. Bald but glowing, she happily greeted me. She informed me that she had intestinal cancer five-years-ago, had been operated on and had chemo, and had been clear until this new invasion showed itself. She chirpily said that the chemo had no side effects and that she’d not missed one day of her six-day-a-week work since she’d been sick save on chemo days. 
“No side effects. Without a tuft of hair on your head and face left and you feel you have no side effects. Wow!” I thought to myself. 
After a bit of chitchat, I ventured as to what she envisioned for her future once her treatments were over. Imagining a rather serious discussion to ensue, I was surprised when she strongly informed me that she was not worrying or even thinking about the future. “It’s a waste of time to worry about such things. I am living for today. Once I am off this bed, I am back to work.” 
Wondering if she was avoiding the harsh realities confronting her, I asked what her life has been like and what makes her happy at present. She merrily told me about her family, her work, and her beliefs. She felt she had a good life and even though suffering from an array of diseases such as diabetes, high blood pressure, and cholesterol she was at peace with her lot. 
She then laughed, “So, with all this illness, what’s one more disease? I may have them, but they do not have me. They may destroy my body, but they cannot destroy my way of thinking. I hate sitting around thinking too much; it’s pointless. I pray at times and guide my heart, but even that I am not too serious about. I have a good family who loves and visits me when they can. My two children have grown up and are successful, so I have no worries. I’ve lived well until now. I’ve had a full life and I am ready to go whenever it’s my time. Who knows when that day that will be? I cannot plan for it, so I live day by day, one hour at a time. I eat good food, love my family, and really enjoy the hard work of cleaning for others.” 
Running her hands over her plump, white pajama-clad body she smiled broadly adding, “I will be happy when I get to vacate this old residence in favor of a better one.” 
“You are amazing, and I really admire your way of accepting death and importantly living wholeheartedly until its time for you to ‘vacate your old residence’. I had a near death experience some years ago. Since then, when I remember to at least, I offer prayers of thanks at the end of the day! I ask forgiveness for the wrongs I have done (and promise to make amends when and where able), I acknowledge what I could have done better in order to clear my slate so that I am ready to go without unfinished business or regrets. Like you, realizing that life is tenuous, I embrace it by thanking the day and others for what they brought to me. I thank myself for the things I did well, and then ask if it is meant to be, that I will be blessed again with other such moments after I wake! I have not done this as well as I should have lately.” I wistfully responded. 
With a look of one who truly knew, Bertha took my hand in hers. I asked if I could give her a hug and a kiss. She nodded affirmatively. As I kissed her and told her that I loved and admired her, she mockingly complained, “That’s not fair! I can’t only receive a kiss, I have to give you one too!” 
Not waiting for my response, the humble cleaner of guru proportions, grabbed me in her big arms, embraced me generously, and added a loud smooch. 
***
Usually, when in a Lepto Laze Phase, I am forced to live on a day-by-day and at times an hour-by-hour basis as this dear soul does. I am in no way comparing my health situation to hers; rather it’s my attitude I am comparing. If we are able to honestly face our mortality, limitations, and vulnerabilities positively, we can appreciate our lives and health in ways we may have never envisioned when whole. Each meaningful, energetic, happy moment, has so much value and becomes great gain having been contrasted by deep loss. 
Bertha, like me, doesn’t possess a sophisticated voice to be able to express deep truths. However, her actions, presence, and way of being in the face of chronic illness and death spoke absolute volumes and gave me a well-needed reminder.
Seems to me that she’s mastered what she was here in this incarnation to learn and impart. She assuredly has a lovely new mansion by the beach with dolphins frolicking in the waves, waiting for her to occupy it. I think my eventual new model will be a small caravan—and I am okay with that. But for now, it’s time to use what little energy I have in the offering of gratitude.

I am, again, by contrast, feeling reasonably well, even when running at low battery. And the fullness of truly embracing life, which Bertha so eloquently modeled to me, begins with attitude.

Thursday, 10 January 2019

Protein found more in advanced prostate cancer could be key to preventing drug resistance


A cancer-driving protein is found in the tumours of men with advanced prostate cancer after treatment with hormone drugs but rarely found in early-stage disease, a new study shows.
The findings of the major study, published in the Journal of Clinical Investigation, confirm the importance of a protein called androgen receptor splice variant 7 (AR-V7) in resistance to hormone drugs in prostate cancer.
The research, led by scientists at the ICR in collaboration with researchers in the US led by the University of Washington, also suggests that researchers should look for new treatments that negate its activity.
In the study, the researchers examined biopsy samples from two groups of men treated for early and advanced prostate cancer.
They developed a new antibody to detect AR-V7 in prostate cancer cells, which allowed them to map its levels much more accurately than before.
AR-V7 was found in biopsy samples from three-quarters of men whose cancer progressed after treatment with hormone therapy, and expression increased further in men treated with the advanced hormone therapies abiraterone and enzalutamide.
But the scientists detected it in less than 1 percent of patients with early-stage prostate cancer, before treatment with hormone drugs.

Important role of AR-V7

Prostate cancers use the hormone testosterone to grow and develop. Abiraterone and similar drugs target the androgen receptor, which is found within cells and detects testosterone.
Despite the success of hormone therapies like abiraterone, resistance to treatment often occurs due to mutations and structural alterations which side-step androgen receptor blocking to keep signalling active.
The study highlights the important role of AR-V7 in this process and suggests that drugs developed to reduce its activity could make treatments like abiraterone more effective.
Men without AR-V7 survived nearly three times as long on average compared with men whose tumours tested positive for the protein, when treated with therapies targeting the androgen receptor before chemotherapy, the study showed. 
The researchers also identified a specific 59-gene ‘signature’ in men with high levels of the protein, which could identify drug targets for new treatments in advanced prostate cancer.

Novel therapeutic strategies

Leader of the study in the UK, Professor Johann de Bono said: 
“This is the biggest study to date of AR-V7 protein expression in tissue biopsies from men with early and advanced prostate cancer and shows that the emergence of the AR-V7 protein in cells is an important event in the development of resistance to hormone therapies like abiraterone, which was discovered at the ICR. 
“We saw that AR-V7 expression is rare in the early stages of prostate cancer, but emerges after hormone therapy alongside other mechanisms of resistance – highlighting its importance in the biology of advanced prostate cancer. 
“If novel therapeutic strategies could prevent AR-V7 expression during hormone therapy, it could improve outcomes for men with lethal prostate cancer.”
Source: The Institute of Cancer Research

Saturday, 5 January 2019

Promising news from Australia (Prostate Cancer Research)

Australian scientists have found a genetic marker that could identify which men are likely to develop deadly metastatic prostate cancer and may pave the way for effective treatments.
The federal government is investing almost $800,000 into researching how prostate cancers spread and become impervious to conventional treatment.
Roughly 3500 men died of prostate cancer in Australia in 2018, according to national data.
While localised prostate cancer has very good outcomes - the overall five-year prostate cancer survival rate is 95 per cent - patients with metastatic disease do very poorly.
The majority of these metastasised cancers are resistant to conventional treatments - androgen deprivation therapy - and become untreatable.
Just 30 per cent survive more than five years if the cancer spreads to other parts of the body.
Dr Philip Gregory at the University of South Australia will receive $782,078 from the National Health and Medical Research Council (NHMRC) to investigate a novel molecular pathway that could lead to new, effective treatments.
Dr Gregory’s team found the RNA-binding protein 'Quaking’ is switched on in prostate cancer cells that metastasise.
“Surprisingly we found levels of this [molecule with this specific protein] are strongly indicative of cancers becoming more aggressive and resistant to the therapies,” Dr Gregory said.
This finding was the springboard for the grant.
“We are trying to understand how this molecule functions in prostate cancer. It changes the way genes are spliced so we are hoping the molecule or gene splicing signature might be able to diagnose which prostate cancers will become aggressive,” Dr Gregory said.
“We can make better decisions in terms of treating patients if we can see which particular cancers look to have an aggressive phenotype. Maybe we would take out a tumour earlier or give them more aggressive treatment."
He hopes to eventually be able to design new therapies that would make the cancers less aggressive and more susceptible to hormonal treatments.
“One of the unique things about this molecule is that it works not by controlling levels of genes, but how the gene is spliced within cancer cells. It’s a new way of thinking about how cancer spreads,” Dr Gregory said.
Health Minister Greg Hunt said the research had the potential to save and protect lives.
“This critical research project is among NHMRC grants worth more than $526 million,” Mr Hunt said.
“Through the 2018–19 budget we provided a record total of $6 billion to Australia’s health and medical research sector."
Mr Hunt said since 2013 the government has contributed more $70 million towards prostate cancer research. In 2018 the government subsidised MRI scans for prostate cancer checks.
Kate Aubusson

Kate Aubusson of the Sydney Morning  Herald
January 2019