Friday, June 30, 2006

Cell phone driving distraction

A recently published study looked at performance in a driving simulator of individuals who had blood alcohols of 0.08 (the “legal limit” for intoxication) and those same individuals sober and using a cell phone. They also served as the “control” group driving without alcohol or distraction. Cell phones users, both “hands-free” and hand-held, had poor reactions times and other driving “problems” as frequently, and in 3 instances worse problems, than when they were drunk. In both situations (distracted and drunk) the drivers did not believe that they were affected.

We have seen this in cases through our office. Checking cell phone records and comparing them to the time of the accident, we have seen deaths related to cell phone use and we only see the worst of the crashes. One case sticks in my mind. A young guy went off the road, single car fatal accident, moments after his cell phone received a call and he presumably answered it.

Keep in mind that the distraction “problem” was equal for hands-free and hand-held cell phone use. On the other hand, don’t get me started on some of the other things I see drivers doing while they are driving.

Make good choices, don’t take chances, good luck.

Wednesday, June 28, 2006

Salubrious Coffee

I ran across several articles pertaining to a study published in the Archives of Internal Medicine “Coffee Consumption and Risk of Type 2 Diabetes Mellitus”.

I like it, yet another reason to pour myself another cup of coffee. While I drink coffee because I like it and, at least in small part, because I am addicted to the caffeine, it is nice to know that there are potential health benefits to my consumption.

The study, a part of a larger look at the habits of over 28,000 women and their risk of developing disease later in life, demonstrated basically that the more coffee you consume (likely to some limit point) the less is your risk of developing Type 2 Diabetes Mellitus. Because this held true for both caffeinated and decaffeinated coffee consumption the assumption is that it isn’t the caffeine that is protective. They mention that it is likely due to “minerals, phytochemicals, and antioxidants” contained in the coffee (just linking those words to coffee makes it sound so health imparting to me).

I’m off to Starbucks for my caffeinated (unless it is after 4, then decaffeinated) beverage of minerals, phytochemicals, and antioxidants. Oh what the heck, for that extra health boost throw in another salubrious shot of expresso.

Tuesday, June 27, 2006

Fly larvae

More as a sidebar to yesterday’s post than anything.

It is incredibly difficult to kill maggots. Typical “bug” sprays don’t work. Bleach doesn’t work. Hydrochloric Acid doesn’t work. Salt doesn’t work. They don’t drown in water. (These suggestions can be found, among others, on the Internet- Google killing maggots). Hydrogen peroxide (drug store variety, not rocket fuel concentration, although the latter would likely work, too). Vacuuming them up and discarding them in an appropriate receptacle seems most effective.

What an incredible biological machine.

Let them progress through their life-cycle; flies are easier to get rid of.

Monday, June 26, 2006

Taphonomy (Study of Decomposition)

Decomposition frequently comes up in questions during our office tours and my presentations about the Coroner’s Biz. It also not infrequently “comes up” in my office. Today was such a day. We had a death over the weekend, a body found fairly far along on the continuum of decomposition.

Classically there are thought to be 4 stages. First the body undergoes autolysis, in which body chemicals and enzymes begin to work on dissolving the body, or at least parts of it. At the cellular level certain chemical “pumps” fail, that also contributes to that autolysis. The next phase is bloating and putrefaction. Our internal bacteria (helpful symbiots while we are alive) are responsible for this stage. They travel throughout the body, using our blood vessels (and other “channels”) as roadways. During this phase, gases are generated and released characteristic of the odor of dead bodies (an odor like no other). In addition, these gases are responsible for the body “swelling” that occurs. Next come outside “carnivores”, most particularly the province of the lowly, and very useful, maggot. Maggots arrive early, are incredibly prolific, and very efficient in accomplishing their task, no matter how primal our “fear” of them. The last phase is a dry “rot” breakdown of the last vestiges of the body.

It’s a natural process and as I said quite efficient, but unpleasant (actually a word a bit too understated for the experience) to be around. It is however something we in the Coroner’s Biz have to deal with (at times while wearing respirators). This profession isn’t for every one, but even at it most “revolting” still fascinating and rewarding.

Friday, June 23, 2006

Have a Happy

I heard on the radio this morning that this is the happiest day of the year according to some British researcher (I do not have a link or reference. This is likely true for my 16 year old daughter. The researcher reportedly relied heavily on information seeming to pertain to Seasonal Affective Disorder.

At lunch I attended a fundraiser for Lake County Council Against Sexual Assault and the Executive Director referred back to last year’s luncheon and speaker who said that getting involved can help you be happier, live longer and be healthier. That would be consistent with the Positive Psychology research areas of “life of engagement” and “life of affiliation”, both beneficially affecting your well-being.

So, to enjoy a long, more enjoyable and healthier life get outside and enjoy the sun and fresh air and get involved and help others. Sounds like a pretty cool way to avoid the Coroner’s Office for as long as possible to me.

Thursday, June 22, 2006

Coroner as Career

We had a group of teens in the office today for an educational experience “run” by my Chief Deputy and myself, with others in the office also participating. They were attending a 10-day forum in Chicago (National Youth Leadership Forum) for young people wanting to learn more about medicine-related careers. The forum draws teens and young adults from all over the country for an experiential sampling in their chosen career field. The forum seems to be a great opportunity and we are glad to participate for our 2nd year.

By the end of their 4 hours here (we did give them time off for lunch) several of the students voiced an interest in the Coroner’s “biz” as a future career choice. This was despite honest descriptions of the downside of dealing with death in all its forms, decomposition, and possible emotional investment/toll. As always it was great to throw in a few “preachy” moments, about making good choices, not taking chances and, possibly< forestalling death.

Who knows how many (if any) will ultimately choose this field for their career, but it was great seeing their interest build and our ‘love” for our work reflected back from them.

Wednesday, June 21, 2006

Darwin Awards

I talked to a summer high school class yesterday and really enjoyed the experience, certainly as much as other presentations I have done. I give them information about what I do and the Coroner’s Office business mixed with tidbits on how they can forestall death, make good choices and not take chances with their lives.

I did get one question that I did not answer: “Have you seen any deaths that would qualify for Darwin Awards?” (paraphrased) While I admitted that some might fit that categorization, I (and my office) don’t approach death that way.

However, I thought some readers might not know about the “Awards”, so I thought I’d through up a link and a bit of information about the “Awards”. The Wikipedia entry makes interesting reading, nonetheless.

A Darwin Award is a tongue-in-cheek honor given to people who purportedly improve the human gene pool by removing themselves following from an episode of questionable judgement. The prizes, named after pioneering evolutionary theorist Charles Darwin, are awarded over the Internet. There is no monetary prize, only (necessarily) posthumous recognition.


And
Not Darwins
The following have been specifically stated as being no longer eligible for a Darwin Award, as they are too common:
Smoking in an oxygen tent
Being hit by a train or automobile
Climbing into zoo cages
Falling off a precipice while posing or urinating (spitting is perilously close to being added to this list)
Urinating onto electrified wires, subway rails, etc.
Certain forms of carelessness with flammable liquids
Plain alcohol poisoning. Alcohol consumption, on the other hand, plays a key role in many Darwin Awards.
Deliberate and willful acts; doing it on purpose steps from Darwin Award to insanity.

Read and enjoy the irony of the “Awards”

Tuesday, June 20, 2006

No Fault Decisions

More just as a point of information about the Coroner System:

I came across a letter to the editor from a paper in Australia (through a Google search and “feed”) that mentions an important point about the Coroner’s system: “The focus of a coroner’s inquest is to establish a cause of death, not whether anyone was at fault.”

As the author of the letter states: “This prohibition can seem strange to people unfamiliar with the coroner’s role.” Indeed, this does cause some confusion for jurors and, at times, the friends and family of decedents. Particularly in certain cases everyone wants to assign blame, somebody must be responsible. But blame/fault-finding is specifically precluded from the proceedings. It is the job of the police and the legal system (criminal and civil) to assign blame/responsibility.

The Coroner and the inquest decide the cause and the manner (natural, suicide, homicide, accident, undetermined) of the death. Findings from the Coroner’s Office investigation and inquest may be turned over to the “authorities”, but they may not be admissible in court.

Liability is the purview of the other branches of Justice, as it should be.

Monday, June 19, 2006

GPS-based Speed Warning

I caught an article recently about a “new” gadget to warn speeding drivers to slow down. While it is not yet commercially available, I think it will have an eager market. However, I do want to mention that years ago my grandfather had a somewhat similar device on his car, so it is not all together new. While not so “gadgety” as this device, it beeped when the needle on the speedometer reached 40 MPH and again at 50. While he rarely drove more than a mile from his home then, he was a bit of a lead foot and was ticketed once too many times for his liking.

What is new about this gadget is three-fold: 1) it will sense what the speed limit is on a given stretch of road, 2) it displays that speed limit on a screen, and 3) it sounds an alert when that limit is exceeded. It likely will cause at least some of the folks to slow down, avoid speed related crashes and save some lives (a good thing). The other thing it does is records speeding violations in memory. This will allow parents to monitor their teenagers’ driving habits (remember driving is a privilege).

I wonder if they will be out soon, my daughter is 16 this week (although, of course, I trust her implicitly).

Friday, June 16, 2006

Death by Lack of Insurance, visiting again

At lunch the other day I was discussing problems uninsured individuals have accessing medical care and the need for total system change. (It wasn’t a random conversation, the discussion was between myself and the individual who took over as Executive Director of the free medical clinic I was running when I was elected Coroner.)

Why hasn’t something been done to help the 48 million Americans without health insurance? It was my point (echoing many others) that historically low-income individuals have been the super-majority of the uninsured. Low income individuals have no power, no clout, “no one” listens to them.

I also made the point that the demographics are changing and with that change is coming renewed attention and re-evaluation of this issue. More moderate- to middle-income families are facing loss of insurance and its attendant risks of ill-health and financial ruin. More people, many 50-65 years old, are facing the prospects of being uninsured. These are people who can be heard, who can use their clout. It is terribly unfortunate that this is what it will take to get the issue addressed, but I see it coming.

Medical debt is crushing people who have no insurance. It has become an issue for individuals with insurance (62% of adults with medical debt were/are insured).

The inability, or severely circumscribed ability, to get insurance on the private market is hitting even those with the money to afford to pay for it.

Lack of medical insurance limits access to healthcare. It limits an individual’s ability to properly manage chronic health problems. It limits access to health maintenance and disease prevention/early screening measures. It contributes to the death of these individuals.

Tuesday, June 13, 2006

Ultimate Decision

The article begins with a quote: “It’s a problem” a comment prompted by a recent weekend in which there were 3 deaths by suicide in Lake County. Quite the understatement considering deaths by suicide in Lake County outnumber homicide deaths about 4 to 1. Really a good, well done article.

There was a nice sidebar that I wanted to highlight:

Danger signs of suicide
• Talk about suicide
• Statements about hopelessness, helplessness or worthlessness
• Preoccupation with death
• Suddenly happier, calmer
• Loss of interest in things one cares about
• Unusual visiting or calling people one cares about
• Making arrangements; setting one's affairs in order
• Giving things away
- Kristen Brooks Hope Center

People with these warning signs need help. Help and support from you, referral to help with professionals, pushed hard if need be. You may save their life. Remember the 4th on the list it can be a “fooler”, they have made the decision at that point, time may be of the essence.

Monday, June 12, 2006

Working to Limit Undreage Drinking

A few weeks ago I attended and participated in the 2nd of 2 community forums set up to get community input into the problem of underage drinking. From the input received at those meetings ranked listings of “problem priorities” and “solution priorities” were developed. The attendees were by and large parents. The lists are heavily weighted with parental responsibility.

Problem Priorities:
1. Peer pressure for youth to drink
2. Parents need for more awareness of and involvement with the problem
3. Parents attitudes toward condoning drinking and communicating with their kids
4. Parental supervision
5. Inconsistency of consequences and messages

Solution Priorities:
1. Educate youth on skills needed to resist peer pressure and to make healthy choices
2. Educate parents on role modeling and communication skills
3. Enforce rules and make them consistent at school, home, police, and in the community and prosecute adults who provide alcohol to minors
4. Explain and enforce zero tolerance
5. Make the issue of underage drinking prevention a priority for everyone in the community



It will be interesting to see what the After School Coalition (the group sponsoring this activity) develops through this process. I do have confidence in their capabilities. I think the target pieces and solution priorities will be manageable to design programs around. I do look forward to my office’s involvement in working with them on underage drinking, its risks and tragic outcomes.

Friday, June 09, 2006

I see my psychiatrist on TV

“Remote doctoring” seems particularly suited to psychiatric patient encounters. Because with telemedicine you can do everything except touch and smell the patient, a specialty that dwells most on listening, talking and treating would be well served by the technology.

Telemedicine has been used for some time to allow doctors in more remote/less populated areas to get consultations with specialists using the eyes and ears of TV. Now there also seems to be a growing trend allowing patients contact with specialists using those same TV technologies. There are many areas in this country, many really not all that remote, without access to psychiatrist services because of the distribution of qualified physicians. These areas despite having population numbers that don’t make it feasible to “support” a local psychiatrist, still have many in need of mental health services. Mental illness exists in those areas just as much in urban areas, often with “complications” unique to their remote location and low populations.

As a matter of fact there are some advantages to telemedicine psychiatry that can make it a good option for certain individuals. Remote doctoring can be less intimidating, less threatening, for some individuals with histories of abuse and trauma. There may also be a degree of comfort using technology we are all familiar with (maybe a bit too familiar) like TV. A human, therapeutic connection across a “cool” electronic connection.

Anything that improves the availability of mental health services should be looked at and if proven effective embraced for the common good. Even one more individual getting adequate treatment and prevention of deterioration and suicide, or other untoward outcome, is a good thing and I would support it whole heartily.

Tuesday, June 06, 2006

Medicalizing rage/anger

I saw a news report last evening that certainly caught my attention. A study by researchers at the University of Chicago’s medical school states that “intermittent explosive disorder” may be more common than previously thought. It may affect up to 16 million Americans, more individuals than are diagnosed with bipolar disorder or schizophrenia.

The definition of “intermittent explosive disorder” involves multiple angry/violent outbursts way out of proportion to the situation. It includes road rage, spousal abuse and throwing things or ‘trashing the place’ in anger. It includes actions up to and including killing someone.

I agree whole heartedly that these individual’s need treatment. They need treatment before they hurt or kill someone or hurt themselves. That treatment certainly includes counseling and, quite possibly, medications. I know that to get insurance to pay for treatment and medication you need a “codable” diagnosis, but aren’t we going too far in medicalizing what in many cases is less a disease and more a behavior problem? No one is responsible if it’s a diagnosable disease/illness. People need to learn to get along in society with all the other folks in society. If their behavior falls out of the range of behavior you need to function properly society, get them the help they need, but don’t tell them they have an illness. Medicalizing such behavior demeans the individual and it demeans their actions (responsibilities are just as much a part of functioning in society as are your rights). It also demeans all the individuals with diseases (psychiatric and otherwise) that require treatment.

Monday, June 05, 2006

Nicotine, the gateway drug

Nicotine is one of the most addictive drugs available, although I might argue for caffeine.

Smoking is psychologically relaxing, while physiologically it is a stimulant experience. Nicotine acts on the “pleasure/reward centers” of the brain. Dopamine, the brain chemical responsible for driving these “centers”, is increased as nicotine circulates through the brain. Dopamine is also the chemical stimulated by other drugs that give a pleasant brain experience. Cigarettes (tobacco?) also contain an as yet undetermined substance that decreases the brain level of “MAO”, the enzyme that breaks down dopamine. Less breakdown means more dopamine bathing the brain and more “pleasure” (a rationale used in some antidepressants).

Smokers continue to smoke (and can’t quit) to keep their brain dopamine levels high. It is not much of a leap to realize that sometimes, and for some people, the nicotine “pleasure” isn’t quite enough anymore. Wouldn’t/couldn’t that lead to desire for other dopamine stimulators and serve as the “gateway” to other drugs?

Friday, June 02, 2006

In defense of MySpace

MySpace is certainly in the news lately. I’ve talked about it for some time; “warned” parents about it (admonished them to keep tabs on what their kids are posting). But I want to make it clear that I don’t think it should be banned or legislatively barred. As I have posted before I think it serves a purpose ‘posters” may be helped by knowing that they are not alone and being able to discuss issues more anonymously and with less stigma or as I read a high school freshman put it: “Social networking isn’t evil, it’s just friends. Growing up, you have to have friends and social ties. Otherwise you feel alone.”

MySpace and other similar sites are indeed “social networking”, although not necessarily truthful. They are places where individuals can make themselves intelligent, funny, interesting, and beautiful, because they control what pictures and “words” are posted. There are no “bad hair days”. There is no verbal tripping, faux pas. They can present a very filtered fa├žade. Posters can also try things out. How will people react to me if I am a bit older? How will people react if I say this or “talk” like this? (Often safer and less threatening to try it online then elsewhere)

Can this sort of activity go bad? Can a post attract a “predator”? Sure (do recall, too, that only 0.1% of youth abductions are by strangers), but just as most teens know not to talk to strangers “live”, most know not to talk with them online (or met with them offline). The same cautions/precautions and skill sets work in real-life and in cyber-life. Teach those skills, emphasize those skills, develop those skills. Banned and blocked sites can be gotten to (I read there are instructions on how to do just that available on the web, wow!). But parents must be parents (and the ‘authorities, too), kids need nurturing, not to be turned loose; by nurturing I mean tending to their needs and watching out and protecting them. It is OK to monitor their MySpace space. It’s OK to ask them questions and challenge them. You are the parent.