Pat Duckett deals with death every day. she works for an NHS trust in which 1,600 people die every year, and she has seen many things. One of her more extreme encounters was when one man asked her to hold a stethoscope over the chest of his dead father while he chanted prayers. “He thought he would wake up and they could take him home in the car. the son said: ‘We’ve got the engine running outside. Wake up, Daddy. It’s time to go.’ I had to say: ‘I’m afraid his heart isn’t going to start beating, because he died last week.”

As anyone who has ever been suddenly bereaved knows, the death of a loved one can have an explosive effect – following the immediate trauma of loss comes a prolonged period of shock, and questions: “When did this illness start?”, “How could someone die so suddenly?”, or just “Why?”

Pat is a bereavement co-ordinator for the North West London hospitals NHS trust, a major acute trust. in the majority of cases, relatives find a way of coming to terms with their loss. but for a significant minority, making sense of what has happened is extremely difficult. “Most people will grieve and be perfectly OK, with support from family,” she says. “They get over it. Grief is, after all, a natural process. but sometimes when someone dies, it is literally incomprehensible to their loved ones.”

Her role is to help the bereaved edge closer to some form of closure. she is not a counsellor, but rather a liaison officer between a hospital and families in mourning. more often than not, her work involves guiding them through medical notes, enabling them to have a better medical understanding of the events that led to the death.

“If a patient is in intensive care, then typically the family is bombarded with a lot of medical information at the time,” she explains. “But then, when the person dies, that’s it.”

I am speaking to Pat in one of her consulting rooms at Northwick Park hospital (whose trust has one of the lowest mortality rates in the country). the room is designed to exude serenity – sunshine cascades through the venetian blinds; a pot of brightly coloured synthetic flowers sits in one corner, and there is a box of tissues on a coffee table. in this room she arranges 40 meetings a month with bereaved relatives, taking them through folder after folder of medical notes, jargon-heavy texts that provide a medical synopsis of the final chapter in someone’s life.

“I’ll explain to them, ‘So at this point, there was an X-ray, which indicated this. then, here we can see that they took a blood test.’” a frequent reaction to revisiting the past in this way is that family members will suddenly realise just how ill their relative was, she says. “In hospital, when you are losing a loved one, it’s very intense. You don’t always listen to what medical people are telling you.”

While guiding relatives through medical notes is a central part of what she does, her role as bereavement co-ordinator involves other strands: she advises families of other services, including counselling, and helps organise funerals when, for instance, families are too overwhelmed to cope, or when elderly patients die in hospital with no apparent family.

Not all bereaved families wish to take up Pat’s services: the majority navigate their own way through grief. but in some cases, that is too hard a path to travel alone. a lot of Pat’s time is spent talking to couples whose children have died unexpectedly, or to families who have suffered a traumatic death, or to those who find it too difficult to accept that someone has died.

“Through this job, I’ve learned the true meaning of being ‘grief-stricken’,” she says. “I’ve encountered a couple who have broken up after losing their child. Grief tore them apart. I’ve dealt with a wife who insisted on seeing her husband in the mortuary for several consecutive days. she arrived each day to dress him ritualistically. she even shaved him.”

Everyone responds differently to death. One of Pat’s mantras is “nothing is wrong in grief”. she almost always honours requests from bereaved relatives, however unusual. a common wish is to touch the body of a loved one: hold their hands, or kiss their foreheads or even wash their face. One woman asked Pat if she could help her retrace the journey her 15-year-old daughter’s body made from the hospital to the mortuary, after she died from a very protracted illness. she then wanted to see where she had been blessed in the mortuary. “And there’s nothing wrong with that,” she says.

While a lot of NHS trusts can provide some form of bereavement advice, the services on offer can vary greatly and there is no standard model, she says. Her role as bereavement co-ordinator was conceived two years ago, the idea behind it partly stemming from the fact that a significant number of complaints to any hospital trust are to do with deaths: according to Pat, 60% of deaths take place in hospital, and 60% of complaints to the Care Quality Commission, the organisation that monitors hospital care, are about bereavement.

The thought was that if bereaved people could be empowered with facts about someone’s death, they might be less inclined to make a formal complaint, and be able to find closure more quickly. Neonatal deaths are often a focus of her work: she will sit down with parents and discuss the, often not wholly knowable reasons why a baby has died before even leaving hospital.

“If people get stuck into protracted correspondence with a hospital, it doesn’t help with their grief,” she says. “What helps is having knowledge about the events that led to that death, so they get a better understanding and proper support, bringing them out of the loop so their grief can progress.” (In the past two years, the trust has seen a drop in bereavement complaints of 48%.)

Pat’s theory is that grief itself has evolved in the last century. “We have lost this pattern of sharing the death in the family. in Victorian times, when someone died, the neighbours would all come in and see the dead person in the parlour. And the family would pay their respects up close with the body.”

She experienced her first sense of true bereavement when her grandmother died. but this was infused with a sense of happiness: “She died at home, after falling asleep with her hairnet on, her brandy glass empty, a smile on her face. it was a kind death.”

If death had dealt a kind hand to her grandmother, it was much crueller to Pat’s father seven years ago. a serious bowel condition meant his gut used to “twist”, resulting in emergency procedures. Finally, he came to Northwick Park hospital (where Pat is now based) to have most of his colon removed. He lost six stone, and was a shadow of his former self. When he succumbed to organ failure it was a release for everyone, she says.

Pat was keen that her own daughter, then aged six, was involved in his death. she encouraged her to “do her homework on her grandpa’s deathbed” then attend his funeral. “I wanted her to see that death is a process that is part of life,” she says.

How has her job changed her view of death? How does she feel about her own death now? “I’m not afraid of it. In fact, I revere death. that might sound odd, but I see it as something phenomenal. the effects of it on families are so powerful, how it casts such a long shadow over so many people. Being involved in that, I feel quite honoured.”

When she started her job, Pat admits she brimmed with enthusiasm, but the work took its toll. she initially saw up to three families a day, but got exhausted – physically not emotionally. she developed intense headaches and decided on a strategy of limiting her meetings to just one or two a day.

The overriding feeling that she has about her job, however, is that she is privileged. every day she finds herself embroiled in the most emotionally profound experiences of people’s lives and for that, she says, she feels deeply honoured.

“I always acknowledge the intimacy of strangers. the people I meet tell me the most intimate things and I’ve never met them before in their life.”

My husband James was 59 when he was admitted to hospital on 10 December last year. He had been feeling lethargic but was not in pain. He was working on the Thursday when he told me when he went to the toilet that he found he had passed black motions.

Doctors said internal bleeding and an enlarged liver could be symptoms of alcohol-related liver disease. I knew that could not be the case with James: he drank four or five times a week, but was certainly not an alcoholic.

He was given blood transfusions and heavily sedated. He really didn’t know what was going on. As the days proceeded, he seemed increasingly agitated, but the doctors put this down to withdrawal from cigarettes and alcohol. Ten days after he was admitted, we received the phone call: he had had a cardiac arrest. By the time we arrived, he had died.

The shock for me, and my son and daughter, was immense. He had died so suddenly. we all wanted to get to the bottom of what had happened. that was when we met Pat. we went through the coroner’s report and began to get some answers.

Pat explained that while James had symptoms exactly like those of liver disease, the breakdown of his liver had been secondary to the main cause of his illness: lung cancer. He’d had the worst form, “small cell” lung cancer, which had spread rapidly from the lungs to his liver and renal glands.

Pat explained the detail calmly and with sympathy. we had so many questions but the doctors were often too busy to answer. I had three more sessions with Pat, which were more informal, less medical. Meeting her helped enormously. I had been angry about the misdiagnosis of alcohol-related disease, but came to understand why it was made, and was more accepting of James’s death.

By Amanda Hromadka, DPT, CLT Physical Therapy for Women, Inc. Published: Tuesday, July 26, 2011 at 2:56 p.m. last Modified: Tuesday, July 26, 2011 at 2:56 p.m.

Did you know the human body has one system that regulates immunity, digestion, and the balance of fluids and proteins? the lymphatic system is complex, and serves a vital role in human health, circulating lymph fluid, which is made up of proteins, fats and other cells, from the skin to the blood system.

The lymphatic system requires healthy lymph nodes and vessels to function efficiently. the most common lymphatic system disorder is called lymphedema. Lymphedema is the accumulation of lymph fluid and most commonly shows up as swelling in the arms or legs, but it can also be present in other areas of the body.

There are two types of lymphedema: primary and secondary. Primary lymphedema means a person is born with abnormal or missing lymph nodes. Secondary lymphedema is caused from trauma or surgically removing lymph nodes. (ie: following surgery for breast or uterine cancer). either way, typical lymphedema symptoms can include: decreased flexibility in the affected arms or legs, increased size of the arms or legs, prolonged infections, feelings of heaviness and/or discomfort, and possibly malignancy.

While there is currently no cure for lymphedema, physical therapy can greatly assist with ideal management. Lymphedema can be treated through the use of Complete Decongestive Therapy (CDT).CDT has four components: skin care, manual lymphatic drainage (MLD), compression, and specifically designed exercise programs.

For skin care, it is important to protect the involved area of the body against any signs of infection or trauma. Lotion is recommended to prevent any cracking of the skin that could eventually lead to infections. MLD is the hands-on process of re-routing the lymph fluid from unhealthy to healthy lymph nodes. this light and gentle massage technique has been proven to reduce the amount of swelling, decrease discomfort, regenerate tissue, and improve venous conditions. MLD helps reduce the size of the swollen area, and the compression garments help maintain the size of the affected area. Compression garments can be ordered in a variety of different pressure amounts, sizes, colors, and textures. These compression garments are to be worn during the day and during exercises. Additional methods of compression may be recommended for nighttime wear. Exercise programs are designed for each individual and can include movements to increase flexibility, strength, stabilization, endurance, etc.

A good CDT program of skin care, MLD, compression, and exercise helps manage lymphedema. Prevention and early intervention are important parts of the success of managing lymphedema. It is recommended to avoid extreme temperatures, infections, and/or trauma to the involved area of the body to significantly decrease the risk for developing lymphedema symptoms.

Physical Therapy for Women offers Complete Decongestive Therapy (CDT) by Certified Lymphedema Therapists (CLT). If you, or someone you know, could benefit from lymphedema management, please call Physical Therapy for Women for more information.

I took my 2 year old leopard dog/ ridgeback to the vet becuase he wouldnt stop drooling, huge puddles and his whole front was soaked. he has no other symptoms, nothing stuck in his mouth didnt get in to anything, no trauma, and he is just as playful as ever. the vet can't figure it out and suggested really expensive neurological testing… has anyone expierenced this with there dog? What could it be?

By Medical Edge may 24, 2011 12:00 AM

Dear Mayo Clinic: If you have a broken bone, can bone marrow leak into your system? If so, how does it affect the rest of your body?

Reply: when you break a bone, fat tissue from the bone marrow can leak into your blood. in many cases, this doesn’t cause any problems. But in some situations, it may lead to a disorder known as fat embolism syndrome (FES). Although uncommon, FES can result in serious complications such as severe lung problems and seizures.

Bone marrow is the spongy tissue inside bones that makes blood cells. fat tissue is one part of bone marrow, and some bones have more fat in the marrow than others. For example, in the body’s long bones, such as those in the legs (femur, tibia and fibula), the bone marrow is made up mainly of fat cells. Smaller bones have much less fat tissue. with a broken bone, fat cells can enter the body’s circulatory system and be carried by the bloodstream throughout the body. This is called fat embolism.

Fat embolism is quite common after major trauma in which one or more large bones are broken. But the body is usually able to clear the fat from circulation without any significant damage. Rarely, though, FES develops and people who have this condition can become quite ill as a result.

The exact cause of FES isn’t well understood. Whether the condition occurs after a broken bone seems to depend, in part, on how much fat leaks into the circulation, as the risk of FES increases when larger bones break and when multiple bones are broken. Men develop FES more often than women, and younger people — particularly those between the ages of 10 and 40 — have a higher risk than older people.

In addition to broken bones, other causes of FES can include the trauma associated with total joint replacement of the hip and knee, and procedures that affect the central section of long bones that contain bone marrow (intramedullary canal), such as certain bone grafting procedures and some types of leg-length correction operations.

FES can affect many parts of the body, resulting in a wide variety of symptoms. Diagnosis, though, is based on the presence of one or more of the following major criteria within approximately 24 hours of an injury or orthopedic surgery: a rash of tiny round spots that appear on the skin due to bleeding under the skin (petechial rash); impaired lung function; and symptoms that indicate problems with the central nervous system (brain and spinal cord). Lung function damage from FES can cause conditions such as hypoxia (the tissues in the body don’t get enough oxygen), and, in severe cases, acute respiratory distress syndrome (ARDS), a sudden failure of the respiratory system. Central nervous system symptoms from FES may range from drowsiness to seizures to coma.

There’s no definitive treatment for FES. once a person develops the disorder, treatment is geared toward minimizing the symptoms and providing supportive care that allows the body to eventually clear fat from the circulation. Common therapies for FES include stabilizing broken bones, managing blood pressure and, in severe cases, using a ventilator to assist with breathing.

Fortunately, most broken bones do not lead to FES. also, when doctors can identify people who may be at risk for this condition, they can take steps, such as quickly immobilizing bones that are broken, to help prevent FES from developing. — Tad Mabry, M.D., Orthopedics, Mayo Clinic

Send questions to or to Medical Edge From Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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Useful Information About Acute Pancreatitis

Acute pancreatitis is a very painful and serious health condition. If left untreated it can be potentially fatal. therefore if you care about your health and that of your loved ones it is important to have a basic knowledge of the signs, symptoms and causes of acute pancreatitis.

One of the functions of the pancreas is to secrete pancreatic juice through the pancreatic duct into the small intestine. This pancreatic juice if full of digestive enzymes which, when mixed with bile in the small intestine, digest and break down the food we eat so that it can be absorbed into the bloodstream and provide the cells of the body with the energy they require to function. If an individual develops acute pancreatitis the digestive enzymes do not pass through the pancreatic duct and mix with bile in the small intestine. Instead they attack the pancreas, which is the organ that produces them.

Acute pancreatitis has numerous possible causes. It can be caused by trauma or injury to the pancreas, surgery, gallstones, an obstruction to the pancreatic duct, viral infections, and certain medications. This condition can also be caused by years of heavy alcohol use. If you drink excessive amounts of alcohol or consume a high fat diet you put yourself at greater risk of developing acute pancreatitis.

People who are suffering from acute pancreatitis will experience an assortment of very unpleasant symptoms. These symptoms include heavy pain in the abdominal region, a swollen stomach area, severe vomiting, nausea, fever, a rapid pulse rate, dehydration and dangerously low blood pressure. If acute pancreatitis is not treated promptly it can lead to heart, kidney or lung failure, all of which are potentially fatal.

Fortunately acute pancreatitis is usually fairly easy to treat if the patient is diagnosed and hospitalized in time. first the patient will be given a blood test in order to verify the diagnosis. the patient will then be hospitalized and given intravenous fluids, antibiotics and narcotic pain relief. Until the pancreas has recovered sufficiently the patient will not be given anything to eat or drink, which is why the IV fluids are necessary.

If gallstones were the cause of the acute pancreatitis the patient will require surgery to remove the stones. If the condition was caused by alcoholism the patient will be given counseling and advised to enroll on a detoxification and rehabilitation program in order to help them to stop drinking.

If you have reason to believe that you or somebody you love many be suffering from acute pancreatitis a prompt visit to the accident and emergency department of your local hospital is imperative.

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Just like what happens other than extreme pain?

you could collapse

Low blood pressure, increased heart rate, and a multitude of other signd aand symptoms, depending on the type of trauma.

December 7, 2010 in Bones, Bruises

A bone bruise is an extremely painful injury which occurs because of an injury on the underlying bone part. It can be considered as a prior step to bone fracture. a bruised bone on skin or muscles is not very painful as a bone bruise. Read on to know more about bruised bone.

Causes of Bone Bruise: Bone injuries are the possible causes, which cause intense pain and a feeling of bone fracture, although there is no broken bone. Human bone is made up of cortex. Cortex are interconnected fibers. These comprise of calcium and if you have meet with an accident or a trauma to the bones, fibers break apart. as the bones are interconnected by several fibers, breakage of a few fibers does not lead to fracture, but it triggers intense pain in the afflicted part. Precisely, bone bruises develop only if few fibers break. The breakage of many fibers may lead to bone fractures.

Symptoms of Bone Bruise:Swelling and discoloration in the surrounding area are the symptoms of bone bruise. Intense pain in the afflicted area is the most common symptom. you can often notice blackish-blue discoloration in the surrounding areas of the afflicted bone.

Treatment for Bone Bruise:Initially, you must identify the symptoms of bone bruise. you must consult a medical expert as you identify the symptoms of bone bruise rather than applying medications on the afflicted area. Orthopedic doctor diagnoses the bruise with a high-density MRI scan rather than X-rays. MRI scans give accurate results and hence, minute breakage of fibers can also be detected. This is the only possible way to detect the condition.

Ice packs are very useful in treating thumb or wrist bone bruise. This reduces swelling. you may also use a pack of corns or peas to apply on the afflicted areas. Wrap ice cubes in a soft cloth or a soft towel and apply it on the affected areas. If the pain does not subside, consult the physician for an injection. you are always advised to seek medical professionals advise to detect whether it is a fracture or a bruise.

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Cervical Spondylosis is the most common disorder of the cervical spine. it is caused by degenerative changes in the vertebrae and intervertebral discs that occur as a result of ageing or due to injury or rheumatoid disease. in addition to age and possibly sex. several risk factors have been proposed for cervical spondylosis. Theses are repeated occupational trauma (e.g., carrying axial loads, professional dancing, and gymnastics). Familial cases have been reported. A genetic cause is also possible. Smoking also may be a risk factor. Conditions that contribute to segmental instability and excessive segmental motion (e.g., congenitally fused spine, cerebral palsy, down syndrome) may be risk factors for spondylotic disease. Cervical spondylotic myelopathy (CSM) may be responsible for functional declines in patients with athletic cerebral palsy. in advanced disease this may lead to cervical spondylotic myelopathy (CSM) which results from compression of the spinal cord. CSM is probably the most common spinal cord disorder in people over 55 years of age in the world. as the number of elderly people increases, the incidence of CSM will probably also increase. Cervical spondylosis appears to be primarily a disease of ageing. Characteristic changes on spinal x-rays are present in the majority of people aged over 70 years. A number of factors are responsible for the development of the signs and symptoms of cervical spondylosis. Osteophytes (bony growths) , A narrowed spinal canal present since birth , Degeneration of the intervertebral discs , Changes in the spinal cord and nerves due to insufficient blood supply are some of the common causes. MRI is recommended to assess the extent of the spondylosis and to help exclude other possible causes for the symptoms. A CT scan may also be useful as it gives better visualization of the bony structures. there is no universally accepted treatment for the management of cervical spondylosis. Studies show that up to 20% of patients with CSM will improve spontaneously, 40% will stabilize and up to 40% will deteriorate without treatment. in patients with mild symptoms, a variety of nonsurgical strategies may be used. the most common of these is cervical immobilization. Anti-inflammatory medications help relieve pain and swelling. Postural training and workplace modifications to reduce neck strain may be helpful. other treatments commonly tried include massage, heat, and cold fomentation. if symptoms are severe, such as uncontrollable pain, or progressive worsening of symptoms, surgical intervention is usually recommended. Spondylotic changes are often observed in the ageing population. However, only a small percentage of patients with radiographic evidence of cervical spondylosis are symptomatic. Treatment is usually conservative in nature; the most commonly used treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), physical modalities, and lifestyle modifications. Many of the treatment modalities for cervical spondylosis have not been subjected to rigorous, controlled trials. Surgery is advocated for cervical radiculopathy in patients who have intractable pain, progressive symptoms, or weakness that fails to improve with conservative therapy. Surgical indications for CSM remain somewhat controversial, but most clinicians recommend operative therapy over conservative therapy for moderate-to-severe myelopathy.

 Homeopathy in Cervical Spondylosis:Homeopathic treatment is best suitable for the management of cervical spondylosis. Homeopathic remedies give prompt relief in pain and improve movement. even though the remedies can not bring improvement in degenerative changes in cervical vertebrae and joints which show degeneration or nerve compression but patient experiences significant relief in pain and flexibility of movement. the x — rays may continue to show nerve root compression and degenerative changes but patient experiences far better relief in pain and he is able to have very comfortable movements. Besides long term use of NSAIDS causes other side effects in the body which are not seen with homeopathy. in the management of cervical spondylosis use of constitutional homeopathic approach with use of acute homeopathic remedies whenever found necessary and yoga is the best combination which has proved effective clinically in hundreds of cases.

Dr Harshad Raval MD [Homeopathy]Honorary consultant homeopathy physician to his Excellency Govern.of Gujarat India.Qualified MD consultant homeopath Physician, 25 years experience in Homeopathy fieldMember of nominee advisory committee (Govt. of Gujarat). International Homeopathy Advisor, Book writer and Columnist for Gujarat Samachar,  ADDRESS:16,Floor,White-House| C.G. Road | Ellisbridge | Ahmedabad | Gujarat | IndiaWeb site : homeopathyonline.in Web Site : oligospermiatreatment.com Blog’s site: drharshadraval.com Email us to  Contact us NOW at  +91-9327010414(24/7) +91 79 26400800 +91 79 26431020 Toll free number : 678-965-9251( USA $ CANADA) Only

Dr Harshad Raval MD[hom] Honorary consultant homeopathy physician to his Excellency governors of Gujarat India. Qualified MD consultant homeopath ,International Homeopathy adviser, books writer and columnist. Specialist in kidney, cancer, psoriasis, leucoderma and other chronic disease,. homeopathyonline.in email :

Five days ago I had a glass threw at me and it smashed on my elbow. I couldn't stop screaming because of the pain and the shock from all the blood. I was taken to the emergency room for stitches about 1-2 hours later, they gave me a tetanus shot. since then I have not been able to open my jaw fully. every now and then it will open fully but as soon as I close it it is locked in place, if you know what I mean. They say you can get lockjaw (a symptom of tetanus) from deep cuts which causes bacteria to go on your nerves of your jaw. Could it be possible I got this between the time of the cut and the tetanus shot, or is it simply from the trauma of it all. how do I cure this? Its so uncomfortable, I can't even yawn properly.

it sounds lik TMJ a dislocation of the bones in the hinge of your jaw