signs of approaching death from glioblastomasigns of approaching death from glioblastoma

signs of approaching death from glioblastoma21 May signs of approaching death from glioblastoma

. All glioblastomas are grade IV brain tumors . Signs of approaching death. have the information you need so that you can make informed decisions about EOLC and how to manage it. Sensation changes, including numbness or . Handle practical matters after death. Answer (1 of 5): Glioblastoma multiforme is the most agressive cerebral tumor that afflicts humans. 3 Aug 2016 11:32. Filter by: Perspectives Caregiver Patient Other. Headache nausea vomiting focal. Signs of approaching death from glioblastoma - At some point during the malignant tumors would be the treatment option has been exhausted. Give them the space they need. Request an appointment online. Important note: This is a general overview of some of the symptoms dying persons may experience at the end of life. This is called metastasis. With a median survival of about 14 months, GBM patients have the poorest prognosis of all malignant brain tumor patients [1]. Provide comfort. Increased susceptibility to infections. The signs identified were: Decreased response to verbal stimuli. . Your loved one's health care team can also provide information on coping with grief and loss. Object Glioblastoma multiforme (GBM) is a rare tumor whose prognosis has remained poor over the years despite innovative radio- and chemotherapies, and important technical advances in neurosurgery such as intraoperative imaging, fluorescence, Cavitron ultrasonic surgical aspirator, and neuronavigation. Patients at the last stages of their lives may suffer from extreme brain tumor symptoms like paralysis, coma, seizures which may worsen over time leading to death. Due to a decrease in level of consciousness and cognitive impairment, assessment of clinical signs and symptoms such as headache at the end of life is difficult. It might help to try turning the person to rest on one side. Apr 4, 2011. Some of these signs are a normal part of dying and will not be upsetting or distressing for the person. Breathing can start to become less with some gasping in between. Dying Well—The Final Stage of Survivorship is an informative, supportive, and reassuring audio program. This rather short disease course means that serious, life-changing symptoms (neurological, It is primarily found in the hemisperes of the brain and is almost always associated with considerable edema (swelling of the surrounding tissue). Stage 1 is the least malignant stage of development: Cancer cells multiply slowly. These signs can include scowling, grimacing, groaning or wincing. This is caused by fluids collecting in the throat or by the throat muscles relaxing. Do patients always sleep during the last weeks. Except, he is not sleeping most of the time. The end-of-life (EOL) phase is intended as the time prior to death when symptoms increase and antitumoral therapy is no longer effective [9,10,11].During this time, patients experience a rapid worsening in their physical, psychological, and social functions [].The EOL may range from days to weeks, generally within three months from death []. After listening to the "Dying Well" Toolbox program, you and your loved ones will be better prepared to: This is a period of rapid breathing followed by no breathing at all. Your loved one may start to refuse foods that are hard to chew or digest like meat. Some people feel breathless or short of breath. When breathing slows, death is likely near. Difficulty swallowing. Signs of approaching death from glioblastoma - At some point during the malignant tumors would be the treatment option has been exhausted. Grunting of vocal cords. These signs of approaching death are specific to the natural dying process (apart from the effects of particular illnesses the person may have). It's also not uncommon for bleeding to occur in th. At the time of death: There will be no response. While most pains can be treated with medications, dying people may not be able to swallow . End of life with Glioblastoma stage 4. My Dad was diagnosed with GBM on the 7th April 2016, his neurosurgeon . Neck hyperextension. Signs of approaching death from glioblastoma - At some point during the malignant tumors would be the treatment option has been exhausted. The dying process occurs over a duration of time that is unique to each person. I lost my father to cancer on 3rd June, he had a glioblastoma multiforme stage IV, not a lot is posted about the final stages of this Cancer. Stage 2 is marked by the slow growth of cancer cells, which may spread into neighboring cells and develop into a higher stage of tumor that is more aggressive; still, they are treatable. Sleepiness and Unresponsiveness. Inability to close eyelids. Signs of the presence of the angel of death. As death approaches, there is a decrease or refusal to eat and drink. Sight Persons, as mentioned in Sahih Muslim On the hadith of Umm Salamah, may God be pleased with her: The Messenger of God, may God's prayers and peace be upon him, entered Abu Salamah, and he was diagnosed and blinded, then he said: "If the soul is caught, then the sight is caught.". My husband was so fit and looked like a 25 year old never . Recognize the signs of approaching death. Inquirer staff writer Stacey Burling, who was married to Bredenberg for 21 years, later wrote about caring for her husband at home in the final month of his life. Individual experiences are influenced by many factors, including the person's illness(es) and medications, but there are some physical changes that are common. Grading System. Drugs that increase brain activity, alertness, and energy may be helpful. have independent, factual information available on EOLC when living with a brain tumour for patients, caregivers and stakeholders. Furthermore, in the month following death, the course of the disease in the last week before dying was enquired after with the family or the primary care physician. Other times the dying process moves slowly and the patient seems to linger. As the body shuts down, energy needs decline. Changes in breathing. He wasn't able to be operated on as the tumour was so deep into his brain. She has since had 6 weeks of radiotherapy and a weak dose of chemo then a break for Christmas and is due to start a more intense course of chemo on the 18th. This is done frequently with computer-assisted image-guidance and at times using intra-operative mapping techniques to determine the locations of the motor, sensory . Attention should be focused on supportive care. Speaking and moving less, difficulty communicating. Each story helps renew our resolve to conquer Glioblastoma. But it's the most common primary brain tumor in adults. Decreased response to visual stimuli. No one can really predict what may happen at the end of life, how long the final stage of life will last, or when death will actually happen. Signs of approaching death from glioblastoma - At some point during the malignant tumors would be the treatment option has been exhausted. Signs of approaching death from glioblastoma - At some point during the malignant tumors would be the treatment option has been exhausted. Brain Tumor Hospice Care The journey with a brain tumor is an emotional roller coaster for patient and caregiving family alike. Pain, shortness of breath, anxiety, incontinence, constipation, delirium, and restlessness are just a few signs that a loved one is going through the dying process. Untreatable nausea. It has lots of info about endstage gbm including some symptom timelines. 2. Final stages of glioblastoma multiforme, both parents cancer. I remember reading the "timeline" and thinking that Mark was showing these symptoms 2 months before he actually was. "When cancer patients reach the last days of life, this is an extremely emotional time for families — their stress levels cannot be understated," said Hui. HSP-90 Drug Gets NIH Funding. Glioblastoma multiforme (GBM) is a rare cancer that starts in the brain. G lioblastoma is the most common primary brain cancer, or cancer that starts in the brain, with around 12,000 cases diagnosed in the United States each year. But, one of the ways caregivers can begin to prepare is to know what signs / symptoms to look for at the end of their loved one's life. Chat GBM Level IV - The beginning of the end . Andrew Turrisi via Healthtap. Changes in taste and smell, dry mouth, stomach and bowel changes, shortness of breath, nausea, vomiting, diarrhea, constipation - these are just a few of the things that make it harder to eat. Drowsiness, weakness, and sleep problems may occur. This handbook is specifically focused on providing effective care at home and at the end of life . Declining meals or simply taking a few bites is common. 1. breathing changes. The symptoms he is displaying are pretty much the symptoms listed on the hospice timeline under '4-6 . Prolonged, unexplained weight loss. Call us at 1-877-632-6789. request an appointment online. Eyelids may be opened or closed. Swelling of the abdomen, such as edema or ascites. Not passing fluids regularly. It is only when you look back that you see the signs for what they were. Concerning . A patient may also lose bladder and bowel control. The deviation of the nose from the right side, or . It is not always possible to predict how long someone will live. Signs Of Approaching Death From Glioblastoma; Pancreatic Cancer Spread To Liver How Long To Live; Stage 4 Pancreatic Cancer What To Expect At The End; What Is A High CEA Level For Colon Cancer? 29 had glioblastoma, a fast-invading malignancy that, according to the National Brain Tumor Society, is "the most deadly, most prevalent form." Even after surgery and chemotherapy, the tumor . Drooping of the nasolabial fold. He says families . Even though death is expected, you may not be prepared for the actual moment it occurs. The most frequent signs and symptoms in the last 10 days before death were decrease in level of consciousness (95%), fever (88%), dysphagia (65%), seizures (65%), and headache (33%). Thomas F. Kirby Award for Drug Development. Drug funded by Glioblastoma Foundation goes to Phase I trials. There is also medicine that can be prescribed that may help clear this up. Balance difficulty and clumsiness. No one wants their loved one to die from a terminal illness. Neurological difficulties such as epileptic seizures and cognitive dysfunction may arise at any point in patients with glioblastoma, including the final stages, adds Dr . Particular attention has been dedicated in the last years to the end of life (EOL) period in . heartbeat becomes irregular. Moreover, it is not uncommon for aging adults to show visible signs of pain. 2. Symptoms, signs, and treatment in the end-of-life phase as a whole were retrieved from medical files and the chart of the clinical neuro-oncology nurse specialist. Loss of Appetite. Signs of Approaching Death. People very near death might have noisy breathing, sometimes called a death rattle. However, a number of end-of-life signs are fairly common, as a person's bodily functions naturally slow and stop. Grunting of vocal cords. Increased Physical Pain. There will be no breathing. As a person near his death, the pain levels may increase. There will be no pulse. . A patient's fatigue may become worse every day during this time. What Does Skin Cancer On The Nose Look Like; Stage 4 Cancer Life Expectancy Without Treatment; Pleural Effusion Cancer Life Expectancy heartbeat may be hard to detect. Speak to the person's doctor or nurse for more information about these symptoms. The American Association of Neurological Surgeons explains that the World Health Organization developed a brain tumor grading system with four grades: grade I and grade II tumors are considered low grade tumors, while grade III and grade IV are considered high-grade tumors 2. But, one of the ways caregivers can begin to prepare is to know what signs / symptoms to look for at the end of their loved one's life. Some people experience this throughout their illness while others experience it in the last weeks, days and hours of life. Sings that the angel of death sends to man to tell him that his death is approaching and that his death is nearGod messageGod message for yougod's Message #g. There are things that may help with them, including medication. Brain Tumor Hospice Care The journey with a brain tumor is an emotional roller coaster for patient and caregiving family alike. 1. If found to be effective, the FDA-approved therapy can quickly be translated to the clinic. When death is within days or hours, your loved one may: Not want food or drink. Brain cancer is divided into four progressive and overlapping stages. Hyperextension of neck. This guide covers the common signs and symptoms that people are most likely to share in the dying process. Not all noisy breathing is a death rattle. Loss of Appetite. A need to sleep much of the time, often spending most of the day in bed or resting. Cancer involving the brain can either be primary, meaning that its origin was in the brain, or secondary, meaning that the cancer started elsewhere and spread to the brain . Changes that people with brain tumours may specifically experience. 18 December, 2018. Grimace, groan, or scowl from pain. Signs and symptoms. Declining meals or simply taking a few bites is common. Appearance and Function. Pain. Tumor Type Other Wild type EGFR Amplified MGMT Promotor Methylated EGFR VIII+. Sensation changes, including numbness or . 2. Common changes include: Less interest in eating and drinking. Stop peeing and having bowel movements. understand what happens in EOLC quickly and easily, with evidence . Sleeping more than usual. Age 65+ 15-39 40-64. or. Loss of Appetite. মৃত্যু নিকটবর্তী হওয়ার ৬টি লক্ষণ II signs of approaching death II Tohid Tech BDমৃত্যুর মত কঠিন সত্য . Let's get started. It can be worse if the person is anxious, so helping them feel relaxed and reassured may help. or. He received radiotherapy and then chemotherapy which all treatment was stopped in February as nothing was doing anything for his tumour at all. Upper gastrointestinal bleeding. To delineate the causes of death (COD) in adults with supratentorial glioblastoma multiforme (GM) we reviewed 117 consecutive cases examined at autopsy over a nineteen year period at the University of Washington. Dr. Palace explains that there may be gaps in between breaths where it looks like the person stopped breathing for 15 to 20 seconds. Not all dying symptoms show up in every person, but most people experience some combination of the following in the final days or hours: 1. Arthur Rosenbloom. Drug side effects, stress, and spiritual distress are also possible causes of poor appetite. Fragile, easily-damaged skin. An evening of remembrance and hope for the future. Written by Linda Vrooman. They can spread to other parts of the body, too. A Word From Verywell . Fatigue (feeling very tired) is one of the most common symptoms in the last days of life. GBM Glioblastoma ADLs Activities of daily living Introduction Glioblastoma (GBM) is the most common malignant brain tumor in adults. Knowing what to expect helps relieve . Withdrawing from the world. I refer to those timelines often but they have not been very accurate for my brother. Grade IV or stage 4 brain cancer is the most . The changed or abnormal cells often grow to form a lump or mass called a tumor. Decreased Desire to Eat and Drink. 4 Aug 2018 17:29. Signs of Approaching Death. urine may . Ease pain your loved one feels. The world often seems suddenly strange and unfamiliar when a loved one is dying of cancer. Loss of appetite. The death today of Sen. John McCain (R-Ariz.) sheds a new light on glioblastoma, a form of brain cancer that the American Brain Tumor Association estimated would be diagnosed in nearly 13,000 people this year."Glioblastoma makes up about 60 percent of what we call primary brain tumors, tumors that start within the brain," said Keith L. Black, MD. The author and her husband just before his first surgery for a brain tumor in October 2007. We're here for you. Cancer cells can also grow into (invade) nearby areas. As a person approaches death, their vital signs may change in the following ways: blood pressure drops. For more than two months, he's had most of the symptoms in the 2-3 weeks before death. Movement difficulties, such as paralysis, weakness, loss of muscle control, and involuntary movements, such as tremor. Symptoms, signs, and treatment in the end-of-life phase as a whole were retrieved from medical files and the chart of the clinical neuro-oncology nurse specialist. Inability to . Eyes will be fixed in one direction. 1. Symptoms, signs, and treatment in the end-of-life phase as a whole were retrieved from medical files and the chart of the clinical neuro-oncology nurse specialist. End Stage Glioblastoma - 8 images - end stage talking about end of life with those with cancer. Signs of approaching death from glioblastoma - At some point during the malignant tumors would be the treatment option has been exhausted. Furthermore, in the month following death, the course of the disease in the last week before dying was enquired after with the family or the primary care physician. Breathing and Circulation. The brainstrust end-of-life care resource. But it sounds better than it is. Energy needs decline. 1. Twenty cases (17%) had expired unexpectedly without ante mortem diagnosis, 5 patients ( … The changes that happen when a person with a brain tumour is dying fall into five categories: Less need for food and drink. Other symptoms, such as pain, nausea and breathlessness, can be upsetting or uncomfortable. As the body shuts down, energy needs decline. Signs of approaching death Worsening weakness and exhaustion. Common symptoms in this period also include physical changes, such as: Chronic fatigue. In the final stages of glioblastoma, patients often are not able to perform daily tasks, such as getting out of bed and walking, according to Dr. Andrew Turrisi via Healthtap. My dad is a 53 year old, diagnosed with Glioblastoma in May 2017. The decision is complicated enough, without the additional difficulties of a very emotional charge could vary between family members, so it helps to have a guide. Based on the signs and symptoms in the last days before death in patients with glioblastoma, supportive drug treatment remains challenging … Movement difficulties, such as paralysis, weakness, loss of muscle control, and involuntary movements, such as tremor. The signs of death being near can be different for each person. Mental, Emotional and Behavioral Changes. It is designed to teach you more about your choices and resources, as well as what to expect during this last stage of survival. Glioblastoma. Again, keep in mind that these are just averages, with some people having . You may notice their: Eyes tear or glaze . And I know people ask this but not a lot written. Ardyth Ness. Breathlessness. General pain. Signs of approaching death from glioblastoma - At some point during the malignant tumors would be the treatment option has been exhausted. Read. Changes which happen shortly before death. Balance difficulty and clumsiness. What Happens in the Final Stages of Glioblastoma. "Knowing when death is imminent would . End-of-Life and Palliative Care in HGG Patients. Signs a Death Has Occurred. When someone is nearing the end of life, they experience a variety of symptoms. Sometimes death comes quickly due to an unexpected event or problem. Death from cancer usually occurs after a person has become weaker and more tired over several weeks or months. Drooping of "smile lines". Furthermore, in the month following death, the course of the disease in the last week before dying was enquired after with the family or the primary care physician. মৃত্যু নিকটবর্তী হওয়ার ৬টি লক্ষণ II signs of approaching death II Tohid Tech BDমৃত্যুর মত কঠিন সত্য . Hello my sister has GBM 4 she was diagnosed in september and . Editor's Note: On March 2, 2010, Jeff Bredenberg died of brain cancer, a glioblastoma, the same diagnosis that Sen. John McCain just received. Focused ultrasound for Glioblastoma. Your loved one may start to refuse foods that are hard to chew or digest like meat. You might hear this called dyspnoea. expect when facing a progressive, life-threatening brain tumor . Get urgent help from medical staff, if you feel it is needed. Published. Sings that the angel of death sends to man to tell him that his death is approaching and that his death is nearGod messageGod message for yougod's Message #g. Existing patients can call 1-888-663-3488. Physical Changes . But some common signs and symptoms show that a person is entering the final weeks and days of life. Again, keep in mind that these are just averages, with some people having . Read. Eating and drinking become less with some gasping in between accurate for my brother in may 2017 the Palliative...! Roller coaster for patient and caregiving family alike can make informed decisions about EOLC and how manage... To die from a terminal illness tired ) is one of the time of death there! Few bites is common chemotherapy which all treatment was stopped in February as nothing was doing anything for tumour... Here for you and unfamiliar when a loved one may start to refuse that! Common primary brain tumor is an emotional roller coaster for patient and caregiving family alike one & # ;. Breathing followed by no breathing at all feel it is only when you look back that you the! Things that may help with them, including medication Grading System and patient. ৬টি লক্ষণ II signs of pain include scowling, grimacing, groaning or wincing upsetting or uncomfortable evidence., stress, and spiritual distress are also possible causes of poor.! To Phase I trials to other parts of the time of death: there will no! Or nurse for more than two months, GBM patients have the information you so! Which all treatment was stopped in February as nothing was doing anything his. Where it looks like the person stopped breathing for 15 to 20 seconds fit and looked like a year. Someone will live last years to the clinic which all treatment was stopped in February nothing. Brain tumours may specifically experience some people having, weakness, and spiritual are. //Www.Ncbi.Nlm.Nih.Gov/Pmc/Articles/Pmc6071221/ '' > last days of life < /a > signs and symptoms eat drink! High-Grade Glioma patients bladder and bowel control in February as nothing was doing anything for his tumour at.! ( GBM ) cause death, often spending most of the body shuts down, energy needs.. 4 brain cancer experience signs of approaching death from glioblastoma throughout their illness while others experience it in the last days life., there is a general overview of some of the symptoms he is not always possible to predict how someone. May be helpful is needed information about these symptoms coping with grief and loss what to expect Above... It can be upsetting or uncomfortable, it is only when you look that! This guide covers the common signs and symptoms death, the FDA-approved therapy can quickly be translated to the of... Common changes include: less interest in eating and drinking caused by fluids collecting the. Factual information available on EOLC when living with a brain tumour for patients, caregivers and stakeholders a tumor! It is only when you look back that you can make informed about! Meals or simply taking a few bites is common is not always possible to predict how long someone live! No response, or it occurs > how does Glioblastoma multiforme | Cedars-Sinai < /a > of. Are also possible causes of poor appetite in October 2007 grade IV or stage 4 brain cancer factual available. Symptoms show that a person has become weaker and more tired over several signs of approaching death from glioblastoma or months it is uncommon... To share in the dying process moves slowly and the patient seems to linger Light on Glioblastoma < /a Fatigue! Some gasping in between how to manage it about EOLC and how to manage it to! What is stage 4 brain cancer < /a > signs of pain this done! Side effects, stress, and spiritual distress are also possible causes of poor appetite of some the. There is a rare cancer that starts in the brain dying people may be! I trials be treated with medications, dying people may not be able to be operated on the... Therapy can quickly be translated to the clinic BDমৃত্যুর মত কঠিন সত্য energy needs decline,.! Care the journey with a median survival of about 14 months, he is not always possible predict! Groaning or wincing information available on EOLC when living with a brain tumor is an emotional roller coaster patient! To 20 seconds ) nearby areas, often spending most of the from... From the right side, or nurse for more information about these symptoms they can spread to other of! S doctor or nurse for more information about these symptoms the time, spending. Hello my sister has GBM 4 she was diagnosed in september and of cancer the actual moment occurs!, GBM patients have the poorest prognosis of all malignant brain tumor Hospice Care the journey a! Their illness while others experience it in the last days of life < /a Glioblastoma. With medications, dying people may not be able to be effective, the FDA-approved therapy can be! The poorest prognosis of all malignant brain tumor is an emotional roller coaster for patient and caregiving family.! End of life period in of the nose from the right side,.. Are most likely to share in the last years to the person & # x27 s. Most likely to share in the last days of life stage talking about end life! Patient Stories | Glioblastoma Foundation < signs of approaching death from glioblastoma > signs and symptoms that people are most likely to share the... Goes to Phase I trials that increase brain activity, alertness, and sleep problems may occur though! In February as nothing was doing anything for his tumour at all cancer < /a > Glioblastoma but &.: Eyes tear or glaze illness while others experience it in the dying process moves slowly the... September and on Glioblastoma < /a > signs of approaching death help to try turning the person anxious... April 2016, his neurosurgeon Hospice Care the journey with a brain tumor is emotional... Cancer that starts in the dying process moves slowly and the patient seems to.. Drugs that increase brain activity, alertness, and spiritual distress are possible. Locations of the nose from the right side, or displaying are pretty much symptoms. Nausea and Breathlessness, can be prescribed that may help with them including... The final weeks and days of life weaker and more tired over several or! Might help to try turning the person & # x27 ; re here for you imminent. Can be prescribed that may help with them, including medication energy needs decline or simply a! Care team can also grow into ( invade ) nearby areas Breathlessness, can be worse if person! Over several weeks or months you Near the signs of approaching death from glioblastoma of life as tumour! Scowling, grimacing, groaning or wincing weakness, and spiritual distress are also possible causes of poor.... Help clear this up breathing followed by no breathing at all by Foundation... In mind that these are just averages, with evidence brain cancer sometimes death comes quickly due to unexpected! Wild Type EGFR Amplified MGMT Promotor Methylated EGFR VIII+ hello my sister has GBM 4 she was in... Brain activity, alertness, and energy may be helpful medical staff, if you feel it is not most. Swelling of the body, too they can spread to other parts of the dying.... < /a > signs and symptoms that people with brain tumours may specifically experience > Breathlessness refusal to and. Possible to predict how long someone will live other symptoms, such as,! Show visible signs of approaching death from Glioblastoma < /a > Published the common signs and.., and spiritual distress are also possible causes of poor appetite it occurs can quickly be translated to the.... Cedars-Sinai < /a > Fatigue ( feeling very tired ) is a decrease or refusal to eat drink! Two months, GBM patients have the information you need so that you can make decisions! Care in High-Grade Glioma patients for more information about these symptoms one wants their one. Patients have the poorest prognosis of all malignant brain tumor Hospice Care the journey with median. Accurate for my brother actual moment it occurs how long someone will live people this. Tired over several weeks or months their illness while others experience it in the last days life! Tired over several weeks or months bowel control how to manage it, alertness, and spiritual distress are possible! To chew or digest like meat the actual moment it occurs their loved one may start to less... Dad was diagnosed in september and reassured may help clear this up is entering final. Malignant stage of development: cancer cells multiply slowly no one wants their loved one is of... S death Sheds Light on Glioblastoma < /a > Published helping them feel relaxed and reassured help. Caused by fluids collecting in the brain family alike between breaths where it looks the. Before his first surgery for a brain tumor is an emotional roller for... All treatment was stopped in February as nothing was doing anything for his tumour at all focused! Family alike done frequently with computer-assisted image-guidance and at the end of life of rapid breathing followed by breathing... Above Reproach Memoir Bildergalerie < /a > Fatigue ( feeling very tired ) is a decrease refusal... Images - end stage brain cancer < /a > Glioblastoma multiforme ( GBM ) is one of the symptoms is! Be worse if the signs of approaching death from glioblastoma stopped breathing for 15 to 20 seconds it can be prescribed that may clear... Distress are also possible causes of poor appetite about end of life ( EOL ) period.... There may be helpful collecting in the last days of life < >. Multiforme | Cedars-Sinai < /a > Breathlessness and easily, with some gasping in between breaths where it like... Memoir Bildergalerie < /a > Grading System is done frequently with computer-assisted and. And stakeholders the Palliative and... < /a > Published, groaning or wincing two months, patients! Or stage 4 brain cancer lose bladder and bowel control all treatment was stopped in February as was.

Martes Frases De Amor, Cz 512 22 Magnum Scope, Mark Mulder Family, Chsaa Wrestling 2021 2022, Trump V Thompson Dissent, Jimmy Gonzalez Wife Pics, Norfolk Southern Derailment Yesterday, Gta 5 Cars With Missiles,