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Update May, 2019

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Update by Natrakorn Paewsoongnern


Ready to die yet?

I have it on good authority that unfortunately, the evidence would appear very strong, that we are all going to die. That’s you, Auntie Annie and even me.

OK, that is something we all consign to sometime in the future, and anyway, I’m not ready to die yet. I jokingly proclaim that if you can’t take it with you, then I’m not going! But that is just a good throw-away joke line. Spike Milligan is reputed to have said that he didn’t worry about dying. He just didn’t want to be there when it happened. It is also said that on his tombstone the inscription goes “I told you I was ill.”

What prompted the subject of this week’s column was the death of an old acquaintance of mine. Lovely bloke who took life seriously and would ask me all sorts of medical questions – but those questions were all related to ‘living’. We never discussed ‘dying’.

He had a fall that resulted in a brain injury that rendered him unconscious – a condition he never recovered from and eventually he died, leaving a grieving wife.

Unfortunately, these scenarios do tend to be common place – we are all going to die, and since, in general, we are older than our wives, we can expect to rock up to the pearly gates first to be fitted up with a suitable harp (probably you should take lessons now, and request a comfy cloud).

Unfortunately, whilst it may be ethereal up there, you may have left bedlam down here. As well as grieving wives and family you may have left a financial mess.

Answer this question: when you die, how does your wife get the money necessary for daily living? Was this something you paid her each month, like a salary? But now you’re not there to pay that salary.

Where does your money come from? A pension or a superannuation that is paid regularly directly into your account? And does your wife/partner have any access to that account?

Even if your “exit fees” are covered by an insurance policy, does she know where that policy is kept? Or even the name of the company?

And where is your money kept, once you’ve popped your clogs, you will find the ATM doesn’t want to know you and will eat your credit card. Banks can get very pernickety about people trying to withdraw money from a deceased person’s account, no matter how long they had lived together.

Then there’s wills. If you die without making a will (intestate) then everyone hops in for a slice of the action, right the way through to the gardener and the soi dog. Sorting that lot out takes months (sometimes years), and money is not dispersed until all claims have been verified. (You can relax a bit here – the soi dog won’t get anything.)

However, before you get to the pearly gates, there is another will you should leave with your solicitor, and that is the one called a “Living Will” (all the others are “dying” wills when you think about it).

The Living Will covers your final moments before arriving before St. Peter, or Lucifer, the bloke downstairs.

There are now other important factors which are the basis of the Living Will:

“If I should be in a terminal condition or in a state of permanent unconsciousness. I wish that the treatment be stopped by signing the terms below.”

“I direct my attending physician to withhold or withdraw life-sustaining treatment that serves only to prolong the process of my dying,

I do not want cardiac resuscitation

I do not want Tracheostomy

I do not want mechanical respiration

I do not want Feeding tube

Other (specify)”

Note that this is not euthanasia. This will is to cover what happens in a terminal condition or in a state of permanent unconsciousness, and allows the terminal patient to quietly slide out with dignity.

The correct forms are available at the Bangkok Hospital Pattaya and you can register your Living Will there with your clinical notes.


A genetic problem this week to produce an interesting condition called hereditary hemochromatosis or classic hemochromatosis. This form of the disease is caused by a defect in the genes that control how iron is absorbed by the body.

The Causes:

The amount of iron the human body absorbs is controlled by many genes. Genes can sometimes change (or mutate) in ways that keep them from working properly.

Hereditary hemochromatosis can occur when a person inherits two mutated copies of a gene called the HFE gene — one from each parent. Men and women have the same chance of inheriting two copies of this gene.

Interestingly, not everyone who is born with two copies of the mutated HFE gene develops the disease. Scientists do not know what percentage of people who have two copies of the mutated HFE gene develop the disease. Some studies have shown that as few as 1 in 100 people will develop symptoms. Other studies have shown that as many as 50 in 100 people may develop symptoms. All very confusing.

A person with only one copy of the mutated HFE gene is usually healthy and is said to be a “carrier” of the genetic condition. Carriers usually do not have hemochromatosis. However, if both a mother and father are carriers, a child may inherit two copies of the mutated gene, one from each parent. The child may then develop hemochromatosis.

Risk Factors:

People who inherit the HFE gene mutation from both parents are at the greatest risk for developing hemochromatosis. Although both men and women can inherit the gene defect, men are more likely to be diagnosed with the effects of hemochromatosis than women.

Other factors that increase risk are -


People of northern European descent (for example, people from England, Ireland, Scotland, Denmark, France, and Scandinavia) have a higher chance of having the HFE gene mutation.

Family history:

People with a close relative (grandparent, mother, father, sibling, niece, nephew) who has hemochromatosis have a higher chance of having the HFE gene mutation.

Factors That May Affect Iron Buildup:

For people at risk of developing hemochromatosis, the speed at which iron builds up and the severity of the symptoms vary from person to person. Many people do not have any early symptoms. Symptoms tend to occur in men between the ages of 30 and 50 and in women over age 50.

The following factors may affect the buildup of iron in the body and may speed up or slow down the development of hemochromatosis.

Using dietary supplements:

Taking iron supplements or multivitamins with iron can speed up the rate at which iron builds up in the body. People with hemochromatosis should not take pills containing iron. Eating foods that contain iron is fine.

Taking vitamin C supplements may cause the body to absorb more iron. People with hemochromatosis should not take pills with more than 500 milligrams of vitamin C per day. Eating foods that contain vitamin C is fine.

Blood loss:

Losing iron by giving blood and losing iron through menstruation and unrecognized bleeding may slow the start of hemochromatosis. Therefore, men at risk for hemochromatosis usually develop the disease and its symptoms at a younger age than women who are at risk.


Blood removal. Doctors can treat hereditary hemochromatosis safely and effectively by removing blood from the patient (phlebotomy) on a regular basis, just as if it were a blood donation. Some blood collection centers in the United States have obtained permission from the Food and Drug Administration to collect this blood and use it for transfusion.

The goal of phlebotomy is to reduce the iron levels to normal. The amount of blood removed and how often it’s removed depend on the age of the patient, the overall health and the severity of iron overload. It may take a year or longer to reduce the iron in the patient’s body to normal levels.

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Ready to die yet?