Thanatology: The study of end of life issues PART TWO : The Science and Health Blog ... Page 1 of 4

Login | Manage Account | Mobile | Contact Us | Customer Service | e-Daily site

Web Search powered by YAHOO! SEARCH

News Sports Business Opinion Entertainment Lifestyles Media Jobs Homes Cars Classified

Letters to the Editor Editorials Columnists Perspective Blogs Polls Latest Comments The Observation Post One on One

BREAKING NEWS It's official: Bobby Bowden retires as head coach at FSU

Thanatology: The study of end of life issues PART TWO The Science and Health Blog by Dr. Allen Malnak

Posted September 28, 2009 at 10:25 a.m.

Email Discuss Share » Print A A A

"Attitude toward " from The Teaching of Tecumseh

Live your life that the fear of death can never enter your heart. Trouble no one about his religion. Respect others in their views and demand that they respect yours.

Love your life, perfect your life, beautify all things in your life. Seek to make your life long and of service to your people.

When your time comes to die, be not like those Most Popular

whose hearts are filled with fear of death, Viewed Commented Emailed so that when their time comes they weep and pray for a little more time to live their lives over again Bonita motorcyclist dead after Sunday in a different way. accident Updated 11/30/2009 at 6:34 p.m. 31 comments

Sing your death song, and die like a hero going home. VIDEO: Immokalee employees tied up at gunpoint, $200K stolen Published 11/30/2009 at 7:55 p.m. 11 comments The Dying Process VIDEO: 10 North Naples Middle students suspended for taking part in “kick a Jew day” The dying process usually begins well before death actually occurs. Milestones occur Updated 11/23/2009 at 7:02 p.m. 485 comments along this journey. Because everyone experiences death in their own unique way, not VIDEO: Late-night armed robbery reported everyone will stop at each one. Some may hit only a few while another may stop at at Collier Circle K store each, taking their time along the way. Some may take months to reach their Published 12/1/2009 at 7:02 a.m. 28 comments

destination, others will take only days. We’ll discuss what has been found through Police Beat: Nov. 30, 2009 research to be the journey most take, always keeping in mind such a journey is Published 11/30/2009 at 6:10 p.m. 0 comments

http://www.naplesnews.com/blogs/science-and-health-blog-dr-allen-malnak/2009/sep/28/e... 12/1/2009 Thanatology: The study of end of life issues PART TWO : The Science and Health Blog ... Page 2 of 4

subject to the traveler taking it. Even marathon runners spread out, varying from Photo Galleries finishing first to dropping out shortly after the race starts.

One to Three Months Prior to Death

As one begins to accept their mortality and realize death is approaching, they may Collier County Collier County Collier County arrests 11-30- arrests 11-28- arrests 12-01- begin to withdraw from their surroundings, declining visits from friends, neighbors 09 09 09 even family members. They’re beginning to contemplate their life and revisit old memories. Food becomes less appealing as the body begins to slow down. The dying person is Weather sleeping more now and not engaging in activities they once enjoyed. Altered levels of Currently 36-Hour Your Photos body chemistry sometimes produce a mild sense of euphoria. They’re neither hungry nor thirsty and are not suffering in any way by not eating. It is an expected part of the Currently Today journey they have begun. 82° 82° Mostly Cloudy 68° One to Two Weeks Prior to Death Wind: E 9mph

Mental Changes: This is the time during the journey that one begins to sleep most of More Weather » the time. Disorientation is common and altered senses of perception can be expected. One may experience delusions and hallucinations, sometimes seeing or Calendar speaking to people that aren’t there. They may pick at the sheets and their clothing in a state of agitation. Their movements and actions may seem aimless and make no DEC DEC DEC BROWSE sense to others. 1 2 3 Physical Changes: The body is having a more difficult time maintaining itself. There TUESDAY WEDNESDAY THURSDAY MORE

are signs that the body may show during this time: Free Diabetes Screenings 10 a.m. Sweetbay - Coconut Road

• The body temperature lowers by a degree or more, although fevers may occur. Lecture on squid and octopods 11 a.m. • The blood pressure lowers. Naples Preserve

• The pulse becomes irregular and may slow down or speed up. Lecture on squid and octopods 11 a.m. • There may be increased perspiration. Naples Preserve

• Skin color changes as circulation becomes diminished. This is often more noticeable Tuesday Night Jazz with Father Al 6 p.m. in the lips and nail beds as they become pale and bluish. and the Jazz Congregation • Breathing changes occur, often becoming more rapid and labored. Congestion may Anthony's on the Blvd., 1303 Del Prado Blvd. Cape Coral, 772.5900 cause a rattling sound and cough. • Speaking decreases and eventual stops altogether. Play: "Dial M for " 8 p.m. Florida Repertory Theatre

A Couple of Days to Hours Prior to Death More Events »

There may be a surge of energy as they get closer. The patient may even attempt to get out of bed. This is often labeled “terminal restlessness” and perhaps is part of the “flight or fight” response to the dying process. The energy surge, if it occurs, is usually short lived and then the previous signs become more pronounced as death approaches. Breathing becomes more irregular and often slower. “Cheyne-Stokes” breathing, rapid breathes followed by periods of no breathes, may occur. Congestion can increase causing loud, rattled breathing. It’s one reason health professionals sometimes comment, “Better to die dry than wet.” Hands and feet may become blotchy and purplish. This mottling may slowly work its way up the arms and legs. Lips and nail beds are bluish or purple. The person usually becomes unresponsive and may have their eyes open or semi-open but not seeing their surroundings. It is widely accepted that hearing is the last sense to go so it is recommended that loved ones sit with and talk to the dying during this time. Eventually, breathing will cease altogether and the heart stops. Death has occurred. The life journey has ended.

The Grieving Process and Dr. Kubler-Ross

http://www.naplesnews.com/blogs/science-and-health-blog-dr-allen-malnak/2009/sep/28/e... 12/1/2009 Thanatology: The study of end of life issues PART TWO : The Science and Health Blog ... Page 3 of 4

The grieving process is so complicated, it requires its own lecture. Let me touch on it. You’re all familiar with Dr. Elizabeth Kubler-Ross. In 1969 the Swiss-born psychiatrist conceptualized five stages in facing one’s : denial, anger, bargaining, depression, and acceptance. Although most experts accept the Kübler-Ross stages, they also recognize that these stages occur neither with predictable regularity nor in any set order. Further, the five Kübler-Ross stages are but general reactions to many situations involving loss, not necessarily dying. Seldom does a dying person follow a regular, clearly identifiable series of responses. With some, acceptance may come first, then denial; others may cross over constantly from acceptance to denial.

Palliative and Care

This is a natural place to bring up palliative and hospice care briefly. Both are relatively recent concepts that have changed the way health professionals care for the seriously ill and injured. Unfortunately, until recently for many reasons, health professionals underutilized potent relieving drugs like morphine, Demerol and Dilaudid. Not only was there fear of causing drug addiction, but a number of physicians and others were arrested and charged with over prescribing pain meds without medical necessity. Not to say some were not guilty of this. There are criminals among all professions, but it did scare many to under prescribe necessary relief. ***

The goal of palliative care is to relieve the pain, symptoms and stress of serious illness, whatever the diagnosis or prognosis. It is appropriate for people of any age and at any point in an illness. It can be delivered along with treatments that are meant to cure. Palliative care is typically provided by a team that includes palliative care doctors, nurses and social workers. The team works in partnership with your primary doctor. How does palliative care differ from hospice care? Palliative care is not the same as hospice care. Palliative care may be provided at any time during a person’s illness, even from the time of diagnosis. And, it may be given at the same time as curative treatment.

Hospice care always provides palliative care. However, it is focused on terminally ill patients-people who no longer seek treatments to cure, and who are expected to live for about six months or less. Most hospice care is provided with a home care team consisting of physicians, nurses, physical therapists, social workers, chaplains, even massage therapists. Under certain circumstances care may be provided in an inpatient setting like a nursing home or Georgeson House, an inpatient unit of Naples’ Avow Hospice. Emotional and spiritual support is not limited to the patient but is also extended to family members. have been described as “high person and low technology health care systems.”

To be continued: stay tuned

Email Discuss Share » Print

Recently in The Science and Health Blog by Dr. Allen Malnak More

The Need for Health Care Reform

Can We Fix Our Broken Health Care System?

End of life: Physician Assisted : act of humanity or ethics violation? SERIES FINAL

End of life issues: coma, vegetative state and Terri Schiavo: PART THREE

Comments » 2 Hide

http://www.naplesnews.com/blogs/science-and-health-blog-dr-allen-malnak/2009/sep/28/e... 12/1/2009