Monday, 17 June 2019

Join our Ship!




https://www.facebook.com/groups/1899091816978778/

Two years ago, in the middle of being alcohol-free for the whole if 2017, I started a support group on Facebook for people who weren't comfortable with the amount of alcohol they were drinking and either wanted to seriously cut down or even stop!

Even though I'm a great supporter of One Year No Beer, it was getting too big and I wanted to be in a smaller group, better for getting to know everyone. I decided to Captain a Pirate Ship and collect like-minded crew for that epic journey, and for the first year, the numbers went up so slow I doubted we could ever crew a rowing boat, never mind a galleon!

Now, we have nearly 600 pirates in a support group of all ages and backgrounds from around the world. What's more, we've recently found fair breeze and are growing at 40/50 crew a week!

We also recommend Annie Grace's book 'This Naked Mind' as a key support tool which could change the way you see alcohol; the key to letting it go from your life. You're welcome to join us, we don't turn away anyone and we are a fun bunch of swashbuckling Buccaneers who'll always be there for you.

Regards

Captain Slaughter

Wednesday, 29 May 2019

Prostate gel spacer reduces bowel and bladder damage during radiotherapy

A man with prostate cancer is the first NHS patient in the UK to have a device implanted which can reduce the side effects of radiotherapy by 70%. 
The liquid gel spacer increases the distance between the prostate and rectum to reduce the amount of radiation absorbed during treatment.
It is injected before treatment and stays in place during radiation therapy before being naturally absorbed.
The treatment will now be rolled out to 12 hospitals around the UK.
Prostate cancer is the most common cancer in men, with more than 40,000 new cases diagnosed in England each year.
When it is caught early enough, radiotherapy can be highly effective.
High-energy X-rays are targeted at the prostate, killing cancer cells and preventing them from spreading.
However, the radiation is not absorbed by the prostate, meaning that nearby healthy organs can be affected resulting in side effects including rectal bleeding, erectile dysfunction, bowel and bladder damage.
Alan Clarke, from Bristol, first had radiotherapy in 2011 but cancer returned.
He was selected to be the first NHS patient to receive the spacer because he was considered to be more at risk of suffering side effects from a second course of radiotherapy.
Two syringes mix together the gel so that once injected, it sets within seconds. 
Prof Amit Bahl, consultant oncologist at the University Hospitals Bristol NHS Foundation Trust, said: "The space we have created means the rectum will not get the toxicity from the radiotherapy. 
"In radiotherapy terms this small space will make a huge difference to the patient's quality of life in the long term."
Dr Sam Roberts, director of innovation and life sciences for NHS England, said: "In studies, its use has been shown to relatively reduce life-changing side effects, such as rectal pain, bleeding and diarrhoea, by over 70%, meaning significant improvements in quality of life for those battling prostate cancer."

Tuesday, 21 May 2019

Blocking a specific protein, may be a promising strategy to prevent the spread of castration-resistant prostate cancer

Promising research, but can it come through soon enough?
Researchers at Boston University School of Medicine (BUSM) have discovered that blocking a specific protein, may be a promising strategy to prevent the spread of castration-resistant prostate cancer (CRPC).
Under the direction of BUSM's Gerald V. Denis PhD, researchers have long studied a family of three closely related proteins, called BET bromodomain proteins, composed of BRD2, BRD3 and BRD4, which regulate gene expression. BUSM researchers were the first (in the 1990s) to show how these proteins function in human cancer.
These researchers now have discovered that inhibition of the protein BRD4, but not BRD2 or BRD3, consistently regulated prostate cancer cell migration and invasion.
CRPC is a highly aggressive form of prostate cancer that often leads to the development of lethal metastases. Standard of care treatment for patients with CRPC typically includes a means to disrupt androgen receptor (AR) signalling, and while effective for an average of two-three years, treatment inevitably fails to impede progression due to acquired resistance mechanisms to the AR.
"Our findings are significant because current therapeutic options for CRPC are limited and focus primarily on suppressing prostate tumour cells that rely on AR signalling," explained first author Jordan Shafran, a PhD candidate in the department of molecular and translational medicine at BUSM.
CRPC is a complex, heterogeneous disease, with varying AR states and expression patterns across individual tumour cells. As the disease progresses, prostate tumour cells can become less reliant on AR signalling and use alternative signalling mechanisms to sustain growth and dissemination. "Therefore, it is imperative to identify 'druggable' targets that regulate prostate cancer cell migration and invasion in cells that are either reliant on, or independent of, androgen receptor signalling," he added.
Story Source:
Materials provided by Boston University School of Medicine.

Tuesday, 7 May 2019

Victim of UK bank fraud? 5 things you must do…



I'm delighted to announce that after years of pressing, my case against Lloyds Bank has been accepted as one of the test cases currently being pursued by Noel Edmunds and his legal team.

Take a look at this film clip if you want more information on how to press your case, or maybe you're just interested to watch a major UK bank, finally being investigated by the police for criminal activity.


The Police, The Banking Ombudsman and Action Fraud all failed in their duty to protect the public, but thanks to one man, Noel Edmonds, we are about to see justice delivered.



Lloyds CEO, Antonio Mote de Sousa Horta-Osorio, soon your smile will vanish!







Monday, 22 April 2019

Is there a link between prostate cancer and genetic testing?



More than 164,000 cases of prostate cancer are diagnosed in the United States each year, according to the American Cancer Society. Four out of five cases are localized to the prostate, and the five-year survival rate for those patients is 100%. The survival rate is equally high when cancer spreads to nearby areas of the body. But when the disease metastasizes to lymph nodes, bone or distant organs, the five-year survival rate drops to approximately 29%.
Almost everyone is aware of the BRCA1/2 gene mutation and its linkage with increased risk for breast and ovarian cancer. But we now understand the BRCA mutations also can be linked with aggressive prostate cancer. Men who have these mutations in their DNA are known as germline mutations. Men who have BRCA1 mutation have up to four times greater risk of developing prostate cancer and those with BRCA2 have up to nine-fold higher risk. BRCA2 mutations have been associated with the more aggressive forms of the disease and an earlier diagnosis -- meaning diagnosed at age 55 or younger.
The current standard of care for metastatic prostate cancer is the same for all men, regardless of BRCA status. The first step is to figure out whether cancer responds to treatments which reduce the levels of testosterone in the body (castration sensitive) or whether it is resistant to this treatment (castration-resistant).
Men with castration-sensitive prostate cancer are treated with testosterone suppression known as androgen deprivation therapy. The tumours will respond for many years, but will at some point, become castration-resistant. The patients will then experience a rise in PSA, scans may show new areas of metastasis or patients may develop new cancer symptoms. Other treatments may be added, such as chemotherapy and/or radiation. Surgical removal of the prostate is also a treatment option for men with castration-sensitive or resistant cancer that has not yet spread.
A growing number of oncology clinics are genomic testing to guide treatment in men whose cancer has been castration-resistant. Previously, genetic testing was offered to prostate cancer patients of Ashkenazi Jewish descent for a family history of breast or ovarian cancer, but now consideration should be given to test all castration-resistant patients for therapeutic benefit, along with considerations for family members.
There is a treatment called PARP inhibitor that has been used successfully to treat ovarian and breast cancer patients with BRCA2 mutations because it blocks an enzyme which cells need to repair their DNA. The presence of a BRCA gene mutation, plus a PARP inhibitor, creates “synthetic lethality” and causes the cells to die.
Genetic testing is still rare in the treatment of prostate cancer.
Healthy men from families with histories of breast and ovarian cancer could benefit from knowing their BRCA status, which will help their physician design a surveillance plan to detect prostate cancer early. PAA testing has been controversial because it sometimes detects tumours that don’t need to be treated, and this may lead to unnecessary medical intervention. But because BRCA1 and BRCA2 mutations have been associated with the most aggressive, fastest-moving forms of prostate cancer, an abnormal PSA result in a man with one of those mutations might be taken more seriously.
Men who carry BRCA mutations might also face a higher risk of other cancers, including breast cancer, pancreatic cancer and melanoma. Patients can talk to their doctors as to how to screen for these cancers.
By Dr Monica Rocco

Monday, 1 April 2019

Prostate cancer cells change the behaviour of other cells

Prostate cancer cells change the behaviour of other cells around them, including normal cells, by 'spitting out' a protein from their nucleus, new research has found.
The tiny pieces of protein are taken up by the other cells, provoking changes that promote tumour growth and -- the researchers believe -- help the cancer hide from the body's immune system.
The process has been captured for the first time on video (https://youtu.be/Ye4t9IJpRdo) by researchers at the University of Bradford and University of Surrey. The research is published today [26 March] in Scientific Reports.
Lead researcher, Professor Richard Morgan from the University of Bradford, said: "For tumours to survive, grow bigger and spread they need to control the behaviour of cancer cells and the normal cells around them and we've found a means by which they do this. Blocking this process could be a potential target for future cancer therapy."
The research focused on a protein called EN2 that has a role in early development of the brain but has also been found at high levels in many types of cancer cells.
The team highlighted the protein using a green florescent tag. The researchers then studied its activity in human prostate cancer cells, normal prostate cells and in bladder cancer, melanoma and leukemia cells. They found that both cancer and normal cells took up the protein from other cells.
They also did time lapse photography of prostate cancer cells, taking pictures every five minutes for 24 hours. The resulting video shows the cells eject small parts of themselves containing the green florescent protein that are then taken up by otherwise dormant cancer cells, causing them to reactivate, changing shape or fusing together.
Professor Morgan explains: "We think this is significant because cell fusion in cancer is relatively unusual and is associated with very aggressive disease. It can lead to new and unpredictable hybrid cells that are frequently better at spreading to different sites and surviving chemotherapy and radiotherapy."
Molecular analysis of the normal prostate cells showed that take up of EN2 caused them to express a gene called MX2 that generates an anti-viral response.
"We believe the cancer is trying to minimise the chances of the cells around it being infected by a virus, to avoid scrutiny by the immune system," says Professor Morgan.
"This could undermine the effectiveness of immunotherapy treatments, which try to use viruses to kill cancer by stimulating the immune system to attack it."
The researchers were also surprised to find the EN2 protein in the cell membrane as well as in the nucleus -- which is very unusual for this type of protein. This provides an opportunity to block its action, and the team were able to identify that part of the protein that was accessible at the cell surface to be a potential target for treatment.
Hardev Pandha, Professor of Medical Oncology at the University of Surrey, says: "This work follows on from earlier studies at Surrey where detection of EN2 in urine, after secretion from prostate cancer cells, was shown to be a robust diagnostic biomarker of prostate cancer. The more we learn about prostate cancer the more that can be done to identify and treat this devastating disease."
Source: University of Bradford, UK (March 2019)

Sunday, 24 March 2019

April Fools' Day


Probably the largest non-religious festival celebrated in the western world, yet its origins are as uncertain as whether you’ll fall victim in April this year. The earliest mention of April Fools’ Day or All Fools’ Day came in 1686 England when biographer John Aubrey described April 1st as a “Fools Holy Day.” Way before that, the Roman spring festival of Hilaria, the vernal (spring) equinox paved the way for similar events through the centuries. Held around the 25thMarch in honour of the first day of the year that was longer than the night, it included festivities, games, processions and masquerades, during which disguised commoners could imitate nobility to devious ends. Back to today, you’re gifted an opportunity once a year to get your own back on ‘the boss’ under the protection of “April Fool” but make sure they really do have a sense of humour, or you could end up toast! This is not a practice restricted to individuals but taken up by many large organisations over recent years, perhaps most famously in 1957 when the BBC reported on Italians harvesting spaghetti from special trees. 
This resulted in several hundred asking for information on how to cultivate the ‘spaghetti tree,’ followed by complaints of being humiliated when the truth came out! So, whatever prank you line up, before you cause too much anxiety, make sure you shout, “April Fool!” which will hopefully bring you some forgiveness.
With an Irish background, I grew up drowning in jokes; it was April Fools’ Day every day! My conversations were so peppered with similes, metaphors and sarcasm that foreigners could barely understand me. However, none of those jokes were designed to hurt, just to make others laugh, which encouraged me to learn even more. Irish jokes were something I could live with, in part because I could relate to an element of personal reflection! 
My mother, born and bred in the Republic, used to say things intended as serious, but we would all fall about laughing. “Our Daniel has one of those new ‘sat lav’ things in his car now,” or “I’m too scared to ask Google, they might think I’m stupid." She once saw a rabbit hopping by the side of the road and remarked, “Daniel, do you think that’s a real rabbit?” Stunned, I replied jokingly, “No Mum, it’s one of those new hi-tech ones.” She explained with a straight face how she’d never heard of those things, but what a good idea they were! She would always start a scolding with, “Look at me, this is no joking matter!” We’d all freeze, trying to look petrified, but the slightest twitch from one of us and we’d all crack up, scattering to avoid the far-reaching (low-tech) broom! 
There are the thousands of great jokes that you learn and memorise, stored in a giant ‘Gatling gun’ that you release without warning when the time’s right… Sean and Mick are walking down the road and Sean has a bag of doughnuts in his hand. Sean says to Mick, "If you can guess how many doughnuts are in my bag, you can have them both. "Would that offend you? Maybe if you were Irish? Unlikely though!
Travelling the world, I recognised that in some cultures, jokes don’t exist. When living in Johannesburg, our TV reception was poor, so I informed our friend Freedom that I’d wait for nightfall and go steal the satellite dish from our neighbour’s roof. He was shocked and explained that it was illegal to do such a thing. When I explained that I was joking, he was even more confused. “So, it was a lie?” he said. I replied, “Yes, sometimes a joke can be a lie, but that’s OK because it’s a joke.” The following morning, he came to tell me that he was going into town, and I wished him a safe journey. He said, “No, I’m notgoing to town, it was a joke.” I forced a laugh but failed miserably, then sat with him to try and clarify, and we had endless fun practising. 
So, what is a joke? “A ‘joke’ is a display of humour in which words are used within a specific and well-defined narrative structure to make people laugh and is not meant to be taken seriously.”(Wikipedia)Does that do it for you? Why did the chicken cross the road? In Bangkok? Undoubtedly suicide with a guaranteed outcome! Knock! Knock! Who's there? Cash! Cash who? No thanks, but I'd love some peanuts! Don’t worry, my wife took four takes on that one!
Jewish, Catholic, vegetarian, football, Essex girl, mother-in-law, race, sex, disability, tragedy, any subject now becomes ammo for jokes. After 9/11 the first jokes came out the same day on social media, and I’ve seen it happen with anything that occurs around the world. Why? Maybe that’s the way some of us handle things when they get so bad! “Death smiles at us all, all we can do is smile back.” (Gladiator) 
Then there are the camouflaged jokes; these are the worst kind because they’re always aimed at individuals or minority sections of society. A joke designed to hurt or offend, maybe not intentionally, but under the guise of “It was just a joke,” but often doesn’t feel that way to the receiver! Did you hear about the bulimic stag party? The cake came out of the girl! How do you make a blonde laugh on Saturday? Tell her a joke on Wednesday.Not so good for Bulimic Blondes! My mother-in-law and I were happy for 20 years; then we met each other. Why don`t ducks tell jokes when they fly? Because they would quack up! A bit more general, so less offensive unless you’re a well-read mallard!
Having had a cancer scare recently, I can relate to this one… An old soldier went to a clinic for an MRI and was put into the machine by an attractive, young technician. Sometime later, after snoozing to music, the examination was over, and he was helped from the device by an older guy. The veteran gasped, “Wow! How long was I in there for?” 

Tell your joke, but be aware of your audience. What may seem very funny to some could be offensive to others, and if you’re amongst strangers, you should be doubly careful. Billy Connolly, a master of the profession, said, "I've always been fascinated by the difference between jokes you can tell your friends, but you can't tell to an audience. There's a fine line you must tread, because you don't know who is out there in the auditorium. A lot of people are too easily offended. 
The older you get, the more jokes you’ll have heard, sometimes the same ones coming around incessantly, like Jehovah Witnesses. Still, laugh out loud, it’s good for you! I even laugh at jokes when I don’t get them, it seems fair on the teller! If you’ve got a joke that would make me cry laughing, please send it because I haven’t done that in years! Laughter is a wonderful medicine, it improves your health, and it’s free, fun and easy to do. It triggers the release of endorphins, the body’s natural ‘feel-good’ chemicals, allowing you a greater sense of well-being. Laughter burns calories, improves circulation, makes you more popular, inspires hope and one day, if you’re lucky, you may even die laughing!

Monday 1st April, beware, it could be you!

A selection of my publications in Expat Life Thailand 2016 – 2019




Dying was easy/coming back was harder

How important is Facebook to you?

Prostate Cancer

Retiring to Thailand

Kensington International School


Cholesterol: Are you at risk?

Al-Saray Review

England’s Teachers Heading Overseas.

Visit to Japan.

The Penrith Show

Happy Christmas Story

The Milk Boy

2017 – A year without alcohol

Dear Daniel: A letter to myself, aged 12

Christmases in the 60s

Medical Emergency Bangkok (co-written with Susan Dustin)

The fires that cleanse the soul
&
My Ups and Downs on Internet dating

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.