RNA unplugged

I love this molecule. It is so clever. Where DNA writes the code for our genes, it is RNA which does all the hard work. RNA molecules perform many functions and exist in pre-cursor form as well as spliced, alternatively spliced or even shortened or degraded molecules. All of these are important controls in gene expression and each gene will have it's own RNA processing. But in it's basic form, RNA is transcribed from DNA, a process in which introns of the gene sequence are removed from the final molecule leaving only the functional or coding sequences.

Of course, it's often more complex than that, and there are some very elegant experiments to demonstrate this. So let's concentrate on a more simple experiment that I have worked on extensively. Using a method devised by Chomzynski in 1987, molecular biologists can extract RNA from living cells. As these cells are living and performing all their normal functions, it is possible therefore to get a 'snapshot' of gene activity at the moment the nuclear material is extracted. In this method, total RNA is extracted. This includes tRNA, rRNA and mRNA. I'll continue with mRNA ,or messenger RNA, and come back to the others in another blog.


mRNA is a short-lived molecule. This means that when genes are activated and transcribed, mRNA is then available to be translated into a functional protein. Proteins are made up of blocks of amino acids which confer activity and functionality to the molecule, such as enzymes, hormones and cytokines. But first, it is possible to measure gene expression (activity) in cells and tissues by a method known as real time PCR. For a description of how PCR works see this iconic work by Kary Mullis. *A lot of good work was done in the late 80's, Peter!*


In a clever twist, we can reverse transcribe the mRNA extracted from cells into cDNA, which is simply DNA without introns. Then we use real time PCR to quantitate the amount of gene expression in the sample, relative to a known amount of gene expression. This is a very sensitive method of gene expression, using very small amounts of material, so we can measure large numbers of genes in multiple cells and tissues.
We are interested in gene expression because we know that variations in the genetic code can lead to changes in gene expression, which in turn affects protein production, and this may manifest itself in the body, as shown in diverse conditions from cancer to heart disease and cystic fibrosis in between. All clear?


Well, not entirely. This is true for many genes, but we have been working on a gene for which no protein has been identified, but which is strongly associated with increased risk of cardiovascular disease. This gene is known as a non-coding RNA gene, but how does it influence cardiovascular disease risk? The fact is, we still don't quite know, although we do know a lot about the gene. It seems that the RNA from this gene influences the expression of other genes, particularly cell cycle genes, thereby affecting cell proliferation. If this happens within the arteries around your heart, it could lead to abnormal thickening or inflammation of the artery wall, resulting in a heart attack.


So when you are thinking about complex multifactorial conditions, remember that RNA plays it's part, too.

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ANOTHER DOG CALLED BARNEY

We know five Barney's. They are all labradors or lab retrievers, stubborn, slow and always doing something they shouldn't. Tonight, old Barney was particularly naughty. He didn't want to walk in the rain, but Barney's mate (Jack Russell terrier!) was off the moment the car door opened. Barney waited for his steps to be brought out, then slowly made his way down. Barney's dad called him sternly but he took his time squatting near the path before kicking leaves over his pile of poo. We went in the opposite direction, but could hear Barney being called over and over again.

As we approached the car park we stopped to watch as Barney dashed up the path and straight into the back of car. No problem getting back in the car then, Barney. But with Barney safely in the car and away, we enjoyed the last loop of our walk in quiet contemplation. Oh, for a walk without Barney.

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MOM'S TREE OF LIFE

We scattered Mom's ashes around a particularly lovely beech tree. In the summer she stood proudly full of leaves, her lower branches reaching out to us as we stood together in our sadness and loss. This tree will forever be Mom's tree. Her leaves turned the most stunning autumnal burnt orange and today I noticed they have all dropped onto the rich carpet below.
Leonardo da Vinci noted that the pattern of branching in trees was nature's way of withstanding the elements. Briefly, when the cross section of the trunk matches the cross sections of all the branches at any given height, the tree resisted wind damage. Scientists are going to use this information from nature to design wind-resistant buildings. 

I love the changing seasons and I love the symbolic way Mom's tree reminds me of the life force in us all. She stands tall in the woods, through the seasons, providing shelter under her boughs, just like Mom did. I wonder how she will look draped in snow? And I can't wait to see the first signs of new life in the spring.

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WHAT THE DOG WALKER SAW

Why is it always the dog walker who discovers the body in the bushes? Easy. It's because we are out and about in all kinds of weather, off the beaten track, minding our own business, at least twice a day. We see a lot of things, my 'boys' and I. Don't think we didn't notice the puff of smoke from the ditch, or the pungent smell of cannabis in the woods. We apologise for interrupting the couple in dingly-dell. And what those two chaps were doing at 6am is nobody's business.

We know who's in and who's out and who's putting it about. We are a useful neighbourhood watch team. What a formidable force we could have in the village if all the dog walkers got together to keep an eye on things. We could put a stop to fly-tipping, burglary, anti-social behaviour, off-roading in the woods. But, the one thing we should do is put a stop to dog poo on the paths and pavements. And that would definitely improve what the dog walker saw.

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MOM WOULD HAVE LOVED THAT

We've been saying that a lot lately. Funny, but we used to say it a lot about Granny, too, as in, Granny would have loved that pudding. In the days and weeks after Mom died we were so overwhelmed by her illness and death, that I personally couldn't think of Mom as she was in the months and years before she got ill. Now, nearly fourteen weeks since Mom passed away, I am happy to say that Mom would have loved all sorts of things that we have been doing lately. She would have loved the current series of Strictly Come Dancing, especially Harry Judd. She would have loved watching Roger Federer win the ATP World Tour Finals. And she would have loved hearing about the wonderful black tie retirement dinner we went to on Friday night.

It was one of those unashamedly old-fashioned, understated posh events. There were some charming older men with their quiet wives, not in black tie but in smart suit. They represent a dying breed of professionals, loved and respected. I enjoyed meeting them. I was seated next to an eccentric chap, so bright he could be a little weird, but thoroughly entertaining in an anarchic sort of way. The food was delicious, no flash snails in porridge, simply smoked salmon, roast lamb and vanilla creme brulee. We were very satisfied. 

And then came the harpist. By Royal Appointment to HRH The Prince of Wales! She played beautifully and chatted about her travels with the Royals. Mom would have loved it.

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YOUR DOG ATE MY BUSINESS CARDS

And a box of matches! Thankfully, the matches were not to his taste, so only the box was destroyed. Phew, imagine having to explain that to the vet. Mind you, my husband had an amusing thought that the dog could light his own farts. Perhaps he is a clever dog after all, as his farts are pretty bad, especially after eating the business cards! 
Now, why the business cards? I have a theory about that. He's fed up with how much his human friends work. No business cards, less work? Could be. Perhaps we should try the old fashioned approach though of improving our work-life balance. More time for dogs. You see, I think he's acting up like any four year old who is missing his daddy. So come on, daddy, play ball, now!

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I met a man who asked me about quantum mechanics of DNA...

Not your standard black tie dinner party conversation, Jonathan, but I can talk about anything. Of course DNA structure and function are governed by the laws of physics, bonds must be obeyed, physical restraints respected, spatial integrity maintained. That's at the very heart of chromatin remodelling. Now, I had planned to write next about RNA, but this conversation reminded me that most amateur molecular biologists imagine that DNA is a linear molecule and everything happens along a long, flat line. That's not true. Firstly, you should all know that DNA is in fact double-stranded. Secondly, the bonds between the bases cause a torsion or twist, known as the helix. The entire double-stranded DNA helix is further wound around histones (ordered clumps of proteins), which adds another layer of constraint. And all of this is packed into the nucleus of the cell. Brilliant!

But here's the interesting bit. I have looked at the this very aspect of molecular modelling (biologist speak) or quantum physics (geek speak) using atomic force microscopy. This technique allows the researcher to obtain a topographical image of the DNA molecule undergoing re-modelling; I can see a region of DNA 'open' or 'close' varying only by a single base change in the sequence. This very simple variation in DNA sequence therefore changes the molecular stoichiometry, which affects DNA folding and the accessibility of the gene to factors which promote gene transcription (I promise we'll get to that in the next blog entry). Furthermore, these topographical changes can be predicted using folding software, which helps inform biologists about the type of experiments we should be doing to further elucidate the mysteries of the DNA molecule. Important, I think you'll agree?

And finally, I remember that a Professor I know has published a useful book, which I think I'll have another look at now. To be continued....

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IT'S NOT WHAT YOU EAT...BUT IT DOES HELP

I heard Polly Noble on telly this morning. She makes a lot of sense but changing your diet and lifestyle after a cancer diagnosis cannot shrink tumours. Having a sensible, balanced diet and an active, happy lifestyle will help to protect against many but not all illnesses, and cancer can strike anyone. Polly has added to the debate about chemotherapy treatment with her new book, but the oncologists have heard and seen it all. Be prepared to ask the difficult questions about the expected outcomes from your cancer treatment.

If I'm not making myself clear, it's because I'm trying to be sensitive and open-minded, but to be honest, there just isn't the science to support the argument for nutrition treating tumours. There, I've said it, and I'm not sorry. Tumours need to be cut out or reduced in size, and there are almost endless combinations of surgery, radiotherapy, chemotherapy and biological treatements, for all different cancers for the oncologists to try. 

Holistic and alternative therapies are important, though, because they very often sit alongside the conventional therapies, to support patients and their families. Ideas with food are so important because they give everyone something to do and think about, other than cancer diagnosis and treatment. Sharing a healthy meal as a family gives a sense of normality.

Back to Polly's approach. Polly recommends a low- or anti-inflammatory diet. Now, this isn't entirely wacky. Sufferers of irritable bowel syndrome, for example, know which foods contribute to a flare-up of their condition. But it's easy to see the connection between food and irritable bowel. What is less obvious is the link made by Polly between inflammatory foods like refined foods, high salt, sugary foods etc, and say lung cancer. Yes, cancer is an inflammatory condition, but it is associated with a chronic low-level rise in markers of inflammation in the blood after cancer has already developed. So, eating an awful lot of oily fish and blueberries may reduce these markers of inflammation but won't affect the cancer.

Of course, these foods are really good for us and should be included in every healthy diet, but don't put all your hopes on a wonder cure for cancer. It's almost always hard work beating cancer. Use all the resources you can. Eat well, live well, surround yourself with positive people, find your inner peace, see yourself well, but don't give up on conventional treatment.

You are all in my thoughts.

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LET SLEEPING DOGS LIE...BUT NOT IN MY BED!

In a moment of ill-advised weakness, I allowed the dogs to sleep on our bed. I wasn't feeling very well and the 'boys' were a great comfort. However, as I am the responsible adult in this menage a trois, I fully expect to be obeyed at all times. So when I said no today, I meant no, I am sleeping in my bed and dogs must sleep on their own beds. Imagine my surprise when I later found not one, but both dogs sleeping on the (cream embroidered duvet with a royal blue velvet cover) spare bed. I drew a sharp intake of breath and the slumbering ones gently harumped in my general direction. (For non-boxer owners that's a widely accepted voice of dissent). I stood my ground and pointed, down! now! They skulked off, giving me a hurt sniff as they walked past me. 

It's been a cold day, so they have been indoors quite a bit, in between walks and games, and barking at the neighbours' children in the woods. And, it's been quite a battle of wills, me against dogs on the bed. I have prevailed. I am the boss, but nobody told them.

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CAN'T POO, WON'T POO!

So, we had an interesting walk this afternoon. OK, it was wet and windy, and a few leaves landed on our heads. Also, it got dark really quickly which made it quite spooky in the woods. Still, I was up for a nice walk, shame about can't poo, won't poo, my two boxers.

Can't poo has had a bad tummy this week, most likely due to something he shouldn't have eaten. I think it might be the acorns near the summerhouse, but it could be anything, and he has eaten far worse! He seems to be over it now, but hasn't eaten very much today, hence not much poo.

Won't poo is just being difficult. OK, I admit I did splash water on his bum, but the puddle looked so inviting in my wellie boots. And I did kick a big pile of leaves in his general direction; they made a whoosh noise, which could have sounded like a deer in a pile of leaves, but wasn't. Anyway, that meant that he refused to do a poo for the entire walk, but promptly farted in the hall when we got home. Nice one.

Sometimes I think that these dogs see the walk as necessary for my well-being, not theirs. They could be right.

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HOW LONG HAVE I GOT?

That's a question Mom never asked, although she really wanted to know the answer. Sadly, the prognosis for Mom's lung cancer was six to eight months from diagnosis, even with chemotherapy treatment, and that hasn't changed in over twenty years. It's not through lack of trying to find better treatments for small cell lung cancer, it's simply that by the time it has been diagnosed, it has often spread beyond the lungs and chest cavity and therefore surgery is not an option.

A report this morning shouts the headline that median cancer survival has increased to six years over the last forty years. That means that roughly half of all cancer sufferers will survive for six years after diagnosis. Is this worth shouting about? Some people will live longer than this and die of something other than cancer, but some people will not live past the first year following diagnosis. It's a cruel lottery.

Ellie Jeffery has updated her blog today and she is starting a new chemotherapy drug to help her fight off secondary breast cancer which has spread to her brain. Ellie is twenty-eight years old. The statistics for this drug, eribulin, show a life expectancy of 13.1 months compared to 10.6 months on an established drug.

Keep Ellie in your thoughts.

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DNA unwound

DNA is fascinating. I have spent nearly twenty years getting inside this dynamic molecule, the basic component of human life, that controls hair colour and how long you will live and everything in between.

Every cell in the human body contains this miracle molecule. It's wound up inside the nucleus and can respond to our changing environment. For example, in work I have recently completed, I have been able to measure the rate of response of DNA to conditions mimicking inflammation in the wall of the peripheral blood vessels. Put simply, I created a laboratory model of atherosclerosis, which as you know is a thickening of the arteries, leading to heart attack and stroke. These experiments were important to do because they showed us how the DNA functions in cells from individual people with different DNA variations.

DNA is divided into functional regions, which we call genes. These genes contain naturally occurring variations, which makes us different from one another. Many of these variants are completely compatible with normal life; that is, the cell will grow and divide in the normal way. This is different from mutations such as those in cancerous cells, which cause aberrant cell proliferation and division.

In order for a region of DNA to respond to a signal from outside the cell, it must be in a relaxed or open state. A number of carrier or transport molecules including cytokines are responsible for presenting the stimulus to the open DNA molecule, in the correct functional position or gene. Once this has happened, the region of DNA closes, a bit like pushing a spring between your hands. In this closed the position, the function of the gene is turned off and no other molecules can interact with the DNA. Imagine a very fine orchestra with a very busy conductor making sure that nothing goes out of tune. All these processes happen without our conscious intervention, and that is what makes DNA fascinating.

Techniques developed in the laboratory by some very clever scientists have allowed us to visualise these processes. We can measure them and discern differences in them between different people, who have different gene variants. Thus, we can say that genetics can determine an individual's response to inflammation. But what do we do with this information. Well, in the not too distant future scientists would like to translate this research into the clinical setting so that family and hospital doctors may be able to look at our genetics when deciding on treatment.

Next time, RNA unplugged and proteins unmixed.

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BORED TO TERRIERS

Perhaps it's just me, but I'm seeing yappy terriers everywhere! They are the dog of choice to trail around town, tied up at the window, staring aimlessly at the unrecognisable ankles of the shoppers walking by.

They quiver and shiver, sniff the air, looking like they could take a bite out of me if I get too close. I certainly wouldn't stop to pat one - I'm too frightened of getting a nip and needing an anti-tetanus jab!

Is it cruel to leave your cold, little dog on a lead outside the bakery? I would say, yes. Big dogs wouldn't stand for it. Big dogs have a sense of self-importance and pride. Little dogs just seem embarrassed.

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REMEMBER, REMEMBER, IT'S MOVEMBER

A very good friend of ours has grown a fine moustache to show his support for the Movember charities. After breast awareness in October, it's only right that we should remember mens' cancers, like prostate and testicular cancer.

Like breast lumps, lumps in the testes can also be detected by self-examination and being aware of changes will prompt a visit to the GP. Prostate cancer, however, needs a professional approach and this might put some men off seeking help. This Morning have been running men's health clinics all this month, and last week Dr Chris Steele conducted a prostate exam during the show. Paul Ross was the perfect patient and was pleased to hear that all was OK with his prostate. A previous show covered self-examination for testicular lumps and changes. I'm sure these TV programs save lives.

After all, women are aware of breast examination and smear tests. We may not like it, but we do it. As we get older, more of us will develop cancer, so vigilance and early detection is vital.


Men, do your bit, don't hide behind your manliness.

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Nature or nurture?

This is a well-travelled argument, but what does it mean in genetic terms? Who cares, I hear you ask? I do, and so should you.

We now know that many modern illnesses are multi-factorial complex diseases. That means that there is more than one cause of the condition, and often more than one treatment. Cancer and cardiovascular disease are good examples of this. For example, you might hear someone say 'they never smoked, always exercised, the heart attack came out of the blue'. We are told to eat five fresh fruit and veg a day, we are encouraged to know our numbers - blood pressure and cholesterol, we are implored to exercise for at least thirty minutes three times a week. But all of this will mean nothing if your genetics are against you. 


Cardiologists talk of risk stratification. This is a complicated formula which takes into account weight (body mass index), waist to hip ratio, blood pressure, cholesterol levels and family history, amongst other measurements. A family history of heart disease is a strong indicator of a genetic link, but often the science of genetics has not yet identified the culprit gene variant, or variants, or discovered the mechanism of the fault in causing disease.


So, in terms of genetics, the nature versus nurture argument is all about a person's individual DNA pattern interacting with one's environment, the individual lifestyle choices we all make. And both genetics and lifestyle contribute to the overall risk of disease; we just don't know yet what to do about this. But, this is a rapidly growing area of research which it is hoped will yield valuable insights into the risk of cardiovascular disease and cancer.


Fingers crossed.

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BIG DOG, BAD DOG?

There's something peculiar about the owners of small dogs. Firstly, some small dogs are hardly dogs at all. I mean, a toy pom, a dog? I don't think so. Me, I like big dogs. Muscly dogs, dogs full of heart and character.

Unfortunately, we have to share our exercise space with badly behaved, off-lead yappers, usually of the terrier type. They run free, bark in my dogs' faces and generally act more aggressively than is appropriate for their size.

We walk on-lead, obey commands and generally behave ourselves because we are big and look bad. I say we, I mean me and the 'boys'. I have seen small dogs run down the badger setts (dangerous habit!) and chase the deer. I feel it is better to have a long, brisk walk than to run madly in the woods (we do have a large garden, so running and jumping and catching balls happens in a safe environment).

Yesterday, we crossed paths with a terrier off-lead. The owner walked past us as we waited off the path. He didn't acknowledge us at all, but his little terror darted out at us, barking hysterically. My dogs sat and watched but I could feel their tension in the leads. I issued a command to the offending furball - stop! leave! It turned tail and dashed off with a yelp. The owner didn't even turn around to look, he just carried on walking. Shame on him.

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Researchers say ...

How often do you hear the newsreader say those words at the beginning of a news item? Researchers say a lot of things. Sometimes, there are great breakthroughs to tell us about, sometimes its a non-story, or a re-hashed story, an attempt to re-ignite awareness, all part of the games they play to get research projects funded.

I am quite often amazed that some of these projects are funded at all; surely studies into gorilla behaviour is not as important as research into cancer? Perhaps that's a bad example, as cancer research suffers no shortage of funding. OK, what about research announced today that there is a large shallow lake on Jupiter's moon? Certainly, this is interesting research but will it enhance human life on earth today?

I must declare a conflict of interest here. I am an out-of-work scientist. The project I was employed on was a large collaboration across Europe, looking for novel gene variants which could be shown to increase the risk of cardiovascular disease, such as heart attack and stroke. The funding ended in September and there have been no new calls to fund this work. So, not only am I out of work, but three years of promising data from highly technical and skilled work will never find it's way to the public. And hearing the words 'researchers say' in relation to the prevention and cure of cardiovascular disease is a long way off.

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To board or not to board?

Today, I went to see another boarding kennel. That makes five, and to be honest, I wasn't hopeful. You see, my 'boys' have never boarded. Granny and Grandpa have always been on hand to house- and dog-sit. But, since Mom passed away earlier this year, we feel that it just wouldn't be fair to Dad to ask him to do it on his own. Besides which, he's not really in to dog walking or exercising in general. He does do loves and cuddles very well, though.

So, off I went, ready to be disappointed yet again. I arrived as a very excited Molly was being collected by her just as excited owner. I sat in my car and watched them be re-united. I felt quite emotional. Molly is a three year old rescue dog. Her owner was very happy to talk to me about his experience of the kennels, and has been a return customer for ten years. Tick one - happy dogs, happy owners.

Then I met Kate, a lovely doggie people person (tick two) - you know what I mean. I was shown around all the kennels and play areas and I asked loads of questions. I watched the other dogs at play and they seemed just fine. Admittedly, it doesn't have the home comforts, but the kennels have underpaw heating and large grass runs (three ticks!).

I think it will be OK.

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SEASONAL GAME?

Living in the country, we do see an assortment of wild life in the garden. Most will discover the 'boys' and beat a hasty retreat. Others, however, are far more brazen and tend to hang around, taunting the dogs.

At this time of year, the seasonal game of choice is pheasant! Beautiful birds, but of little brain. They stalk among the bushes, scratching in the soil, squawking and shrieking an invitation to the dogs 'Come and catch me, if you can!'

The dogs have never caught anything, I'm pleased to say, but they do have fun trying. Beware moles, rabbits, squirrels and deer....

IS THAT MAD DOG OR MAD DOG WOMAN?

Sometimes its hard to tell where the dogs end and I begin. This is a non-serious blog, for those who know about my mad dogs. Two boxers, mad as a box of frogs, or so the saying goes!

I've got a few stories to share and some ideas on training large boxer boys for domesticity. I will be adding to this blog (mostly) daily and hope that you will enjoy reading about us.

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Reasons to be thankful

More than a decade ago, I was shown a simple way of keeping track of all the good things that happen in life, amongst all the not-so-good things. These reasons to be thankful helped me change my perspective and eventually led to a change of career, going back to university and completing a PhD in molecular genetics. I have continued to do this every day and have kept all my notebooks to remind me of the tentative start I made and how my confidence has grown.

Start with a new notebook and commit to writing down three things every day - three positive things, a kindness shown, a funny observation or a favourite song played on the radio. These three things can be anything positive that has happened to you, or which you want to happen. Try to see the positive in every situation. If someone has disappointed you, try to see their perspective in a positive way. Think of positive ways to influence your life, and write these as I will... or I am... positive statements.

Try it, it works. Good luck.

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TO PURPLE CLOAK AND BEYOND

Mom's illness affected all aspects of my life. My own health suffered as I struggled to keep any minor ailments from Mom. I really found sleep difficult. I would wake in the small hours with thoughts tumbling in my head as I reviewed over and over again new treatments we could try or things we could do differently. I found this technique very useful for calming my sleep disturbance. It's called purple cloaking.

Purple cloaking comes from yoga practice, meditation and the understanding of chakras. Read more on these topics here and here. But, you don't have to know anything about that to have a happy purple cloaking experience.

You can purple cloak at any time or any where. I close my eyes, take a deep breath, and imagine a bright light shining on me. Then I imagine throwing a large purple cloak over my body, feeling comforted by it. Next, I imagine the purple cloak on all those close to me. Purple cloak the people, your pets, your house, your car (if making a journey). Purple cloak those near and far. As you purple cloak, say the name of the person in your head. Don't worry if you drift off or other thoughts come into your head. Acknowledge these thoughts, they are important to deal with but not while purple cloaking, and have come to you because it is quiet. Enjoy!

A FUNNY THING HAPPENED

I believe that our dear departed will never be forgotten because we are their monument. I feel close to Mom every day because I walk my dogs in the woods where we scattered her ashes. It is a beautiful spot and at sunset Mom's tree is gloriously illuminated. So when I lost a silk clip belonging to Mom whilst scattering her ashes in the woods, I was very upset. I had worn it every day following her death and had said I would put it away after scattering the ashes. I noticed it was missing when we got back to the car. We re-traced our steps straight away but it was gone. Until last Saturday, 8 weeks to the day and the hour, when my husband looked down and there it was on the path. I think it's a sign from Mom, and after I have cleaned it, I look forward to wearing it again.

It reminded me about what happened on the day Mom died. I had a notebook which I carried everywhere, containing all the notes about Mom's care, hospital appointments, important numbers, as well as personal thoughts on her disease. Mom hated the book when it came out at meetings so that I could document who had promised to do what and follow-up when things didn't happen on time. My notebook and I were a formidable force.

One of the items in my notebook was funeral arrangements, so when Mom passed away I would really have found that information useful, but I just couldn't find that notebook. One of the nurses said that it would turn up on the day of Mom's funeral. In fact, I found it before then, in a drawer I never use! I am convinced that the notebook was put away so that I could concentrate on that day, the memories etched on my mind, a privileged, shared experience.

What to do about Dad?

Dad is a private man, showing a brave face but crumbling inside. He is lost without Mom, grieving and lonely. He goes to work three evenings a week, and this helps maintain his sense of self, but as he was Mom's main carer throughout her illness, he is struggling to find his identity now. He has friends and social things to do, and has set about putting down a routine of things to do on certain days.

But there is no getting away from the empty house, the constant struggle to provide nutritious meals, making sure he doesn't descend into a chaotic mess. I feel mean that I do inspections of the fridge, the toilets, his bank accounts, but these things Mom did throughout their almost 45 years of marriage. 

I watched Esther Rantzen talking about this very issue last week. She still misses her husband ten years after he passed away, Mom has only been gone 10 weeks. We've got a long way to go. At least, we are open with each other and I have let him know that I know he is struggling with his grief. I have told him about bereavement counselling (for example Cruse) and he is talking to his GP, too.

These websites both deal with loneliness and make suggestions about things to do and who to talk to about loneliness.

Mind

SupportLine

Please keep us in your thoughts.

NOTES ON DEATH AND DYING

Now, this is not about the end. This is about a beginning, an enlightenment. Death is part of life, ashes to ashes and all that. The fact is, however, that sometimes cancer will take our loved ones too soon. It is painful and sad, and very hard to bear.

I can honestly say, though, that the five weeks I spent with my mother before her death, were the most precious I have had and probably will ever know. It was such a privilege to be with her, and to have the time to get to know her as a woman and not just as my Mom.

I read extensively on palliative care and the hospice movement, so that we could implement this for Mom at home (weblinks at the end). The first thing to say is that Mom embraced hypnotherapy as a means of conquering her fear and panic about dying. Her pain was well controlled, she enjoyed eating and drinking, and woke each morning happy to be alive. This meant so much to us as we were drawn to her peace and calm.

Secondly, we discussed openly the process of dying. This is not appropriate for everyone, but Mom asked us to be honest with her and I promised to tell her when she was dying (although in the end, she knew and it was in her control). We planned Mom's funeral, chose hymns and prayers (Mom's favourite in another post).

We took the time to tell all the family and as many of Mom's friends as possible, that Mom was nearing the end. So many people made the effort to come and say good-bye, for which we were so grateful.

The close family prepared for Mom's death by making sure that we had said everything, and most importantly, we wanted Mom to know that we would be OK. Giving your loved one permission to die is a most precious final gift :

(Final Gifts by Maggie Callanan and Patricia Kelley

http://www.maggiecallanan.com/interview_bedard.pdf).

Other helpful information :

http://www.macmillan.org.uk/Cancerinformation/Endoflife/Dyingwithcancer/Attheendoflife.aspx

http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Endoflife/AlwaysThere.pdf

End-of-life strategy to ensure quality care for dying patients - Nursing Times

http://www.nursingtimes.net 29 July2008

End-of-Life Care: Questions and Answers - National Cancer Institute

http://www.cancer.gov/

Letting Go: What should medicine do when it can't save your life?

Atul Gawande http://www.newyorker.com/ 02 August 2010

Prayer of St Francis of Assisi (1182-1226)

Lord, make me an instrument of your peace.

Where there is hatred, let me sow love.

Where there is injury, pardon.

Where there is doubt, faith.

Where there is despair, hope.

Where there is darkness, light.

Where there is sadness, joy.

O Divine Master,

grant that I may not so much seek to be consoled, as to console;

to be understood, as to understand;

to be loved, as to love.

For it is in giving that we receive.

It is in pardoning that we are pardoned,

and it is in dying that we are born to Eternal Life.