Fever

Fever is a sign of infection. Teddy used to get high fevers and chills and it always turned out to be a blood infection. How does the Doctor know she is near the end?  Did he do any tests to see if the Cancer had spread? I am not sure but can't recall of a fever being a sign of near the end.What kind of treatment are they now doing on your Sister?

Sorry, my previous post is wrong, my syster has received already four cycles of quemo and not one as I said.

Jose....the physician mentioned that "fever can" be a sign of imminent passing however; you must await the absolute answer to this.  Often time’s elevated temperatures can be caused by other circumstances also. Only the physician will be able to determine this. 
As a general rule: a very high fever can occur in the last stages of liver cancer.  Additionally I have learned that toward the end a person looses the ability to regulate the body temperature. This pertains to all people in the last stages of life.
You should know real soon.  Know that a tidal wave of good wishes is heading your way.
Hugs and love,
Marion

Jose,

Hang in there!  I know how it feels to be devastated.  Try and jot a list of questions you have for the Doctor.  It's easier to work from a list.  Then make sure your questions get answered.

I'm sending hugs and prayers to you!  Your sister is very lucky to have you in her corner!

Hugs,
Pam

This may help and give some insight.  I received a little booklet called 'Gone from my sight, the dying experience' by Barbara Karnes.

This is only a guideline, nothing is concrete, all is very, very flexible. Death comes in its own time, in its own way.  Death is as unique as the individual who is experiencing it.

Changes begin 1 - 3 months before death occurs.  The actual dying process begins within the two weeks prior to death.  There is a shift that occurs within a person that takes them from a mental processing of death to a tru comprehension and belief in their own mortality.  Unfortunately, this understanding is not alway shared with others.

One to two months prior to death:  Withdrawal
This is the beginning of seperation, first from the world. No more interest in newspapers or TV, then from people, no more visitors then children, grandchildren and perhaps even those person most loved.
This is becoming a time of withdrawing from everything outside of one's self and going inside.  Inside where there is sorting out, evaluating one's self and one's life.  But inside there is only room for one.

This processing of one's life is usually done with the eyes closed, so sleep increases. A morning nap is added to the usual afternoon nap.  Staying in bed all day and spending more time asleep than awake becomes the norm.  Know that important work is going on inside on a level of which 'outsiders' aren't aware.

With this withdrawal comes less of a need to communicate. Words connect to the physical life that is being left behind.  Words lose their importance, touch and wordlessness take on more meaning.

Food:
Energizes our bodies, it is the way we keep our body going. We eat to live.  When a body is preparing to die, it is perfectly natural that eating should stop.  This is one of the hardest concepts for a family to accept.

There is a gradual decrease in eating habits.  Nothing tasts good. Cravings come and go.  Liquids are preferred to solids.  Meats are the first to go, followed by vegetables and other hard to digest foods, until even soft food are no longer eaten.

It is okay not to eat.  A different kind of energy is needed now.  A spiritual energy, not a physical one, will sustain from here on.

1 - 2 weeks prior to death:
Sleeping is most of the time now.  A person can't seem to keep their eyes open.  They can, however, be awakened from that sleep.  There is literally one foot in each world.  A person often becomes confused, talking to people, and about places and events that are unknown to others.  They may see and converse with loved ones who have died before them.  There may be picking at the bedclothes and have agitated arm movements.  There is a seemiing aimlessness to all physical activity.  Focus is changing from this world to the next; thery are losing their grounding to earth.

Physical changes:
There are beginning changes that show the physical body is losing its ability to maintain itself.
The blood pressure often lowers
Changes in the pulse beat, either increasing from a normal of 80 to upward of 150 or decreasing anywhere down to zero.
The body temperature fluctuates between fever and cold
Ther is increased perespiration, often with clamminess
The skin color changes: flushed with fever, bluish with cold. A pale yellowish pallor often comes with approaching death.  (not jaundice)  The nail beds, hands and feet are often pale and bluish because the heart can't circulate the blood through the body at a normal flow.
Breathing changes also occur.  Respiration may increase from a normal 16 - 20 to upwards of 40-50 breaths every minute, or decrease to 9 or even 6 breaths a minute.  There can be a puffing, a blowing of the lips on exhaling, or actual stopping of the rhythmic breathing only to resume.  This generally occurs during sleep.  Congestion can also occur, a rattly sound in the lungs and upper throat.  May be coughing, but nothing can be brought up.  All breathing changes come and go.  One minute, any or all of these symptoms can be present, the next minute, breathing may be clear and even.

One to two days, to hours prior to death:
Sometimes there is a surge of energy.  A person my talk clearly and alertly when before there had been disorientation.  A favorite meal might be asked for and eaten when nothing had been eaten for days.  A person might sit and visit when they hadn't wanted to be with anyone for quite a while.  The spiritual energy for transition from this world to the next has arrived and it is used for a tiime of physical expression before moving on.  The surge of energy is not always as noticable as the examples, but in hindsight, it can usually be recognized.

The one to two weeks' signs that were present earlier become more intense as death approaches.
Restlessness can further increase due to lack of oxygen in the blood.
The breathing patterns become slower and more irregular.  Breathing often stops for 10 - 15 and even 30 - 45 seconds before resuming.
Congestion can be very loud.  It can be affected by positionin on one side or the other.  it still comes and goes.

The eyes may be open or semi-open but not seeing. There is a glassy look to them, often tearing.

The hands and feet now become purplish.  The knees, ankles and elbows are blotchy.  The underside of the arms, legs, back and buttocks also can be blotchy.

Generally a person becomes non-responsive (unable to respond to their environment) sometime prior to death.

How we approach death is going to depend upon our fear of life, how much we participated in that life, and how willing we are to let go of this unknown expression to venture into a new one.  Fear and unfinished business are two big factors in determining how much resistance we put into meeting death.

The seperation becomes complete when breathing stops.  What appears to be the last breath is often followed by one or two long spaced breaths and then the physical body is empty.  The owner is no longer in need of a heavy, nonfunctioning vehicle.

They have entered a new city, a new life.

Summary of guidelines:
1 - 3 months:
Withdrawal from the world and people
decreased food intake
increase in sleep
going inside self
less communication

1 - 2 weeks:
disorientation
   agitation
   talking with the unseen
   confusion
   picking at clothes
Physical
   decreased blood pressure
   pulse increase or decrease
   skin color changes; pale/bluish
   increased perspiration
   respiration irregularities
   congestion
   sleeping but responding
   complaints of body tired and heavy
   not eating, taking little fluids
   body temperature: hot/cold

Days or hours:
   intensification of one to two weeks' signs
   surge of energy
   decrease in blood pressure
   eyes glassy, tearing, half open
   irregular breathing: stop/start
   restlessness or no activity
   purplish, blothcy knees, feet, hands
   pulse weak and hard to find
   decreased urine output
   may wet or stool the bed

Minutes:
  'fish out of water' breathing
  cannot be awakened

-------------------
As I look back and reflect on the last days of my husband Tom's life, all of these things were present, at the times this booklet says they would be.  I hope this information can be of some help to those facing the loss of a loved one.

Go with God, Love and Hugs,
Margaret

Margaret, that was a perfect post! Teddy too followed it almost to a T. I hope you keep that and use it on here now and then. Very helpful and to the point. I do have one question, my own curiosity, do you know why the picking of the sheets and clothes?

re: picking at sheets and clothes...

"Terminal restlessness" is the term I've heard.  From my reading about 80 percent of patients will experience this.  Some of it may be due to comfort issues like a full bladder, a bed sore or medication side effects but there may not be any physical reason.  In some cases something such as a seditive may be prescribed. We were also given something for the rattling sound which helped.

My Mom followed Margaret's flow chart exactly.  Remember that hearing is one of the last senses to go.  I remember whispering in her ear that we would be ok and loved her.....that it was ok to go.....  That seemed to calm her and within a few moments she had left our loving arms and moved into her heavenly father's arms.

These are precious moments you are living.....

Jose, we are all here for you!

Hugs,
Pam

Hi Margaret,

Thanks so much for your post. Much of what you posted is what my dad went through and I can so remember the part about the 1 -2 days and the surge of energy and wanting to eat something, sit up and see visitors etc. Thanks once again for this.

Hugs,

Gavin