Friday, August 31, 2007

Fish for your brain

My mother always told me that fish was “brain food”. Of course the form that it took in my diet at the time was fish sticks. Although I do still crave them from time to time, there are lots of other forms more readily available these days.

Some recent studies bear out that fish is good for your brain (the studies looked primarily at fish oil supplements, although fish in the form of fish is better for you). A recent article summarized several of those studies. Studies in prisons demonstrated a decrease in violence coincident with supplementing with fish oil. Other studies showed improvement in depression. And still others demonstrated improvement in ADHD and autism symptomatology.

Omega-3 oils, one of the major components of fish oil, appear to facilitate the function of certain neurotransmitters improving cellular communication in the brain, which leads to the salubrious effects mentioned above.

So for your brains sake, eat fish regularly. At the very least supplement with fish oils, maybe even the cod liver oil that was used on kids routinely years ago. Of course eat a good, balanced, varied diet as well. Stay healthy and live longer. And, Lord knows, we can all use just a little something “extra” for our brains.

Thursday, August 30, 2007

Tuesday, August 28, 2007

"ask not for whom the bell tolls..."

Imagine my surprise a few days ago:

I had just finished my exercise routine at “the gym” (I don’t know that it quite rises to the level of a “work out”) and was walking out of the building. (Note: I take my lunch in the office so that I can go to the gym some days; I am getting in shape so I can serve as Coroner on into the future) As I walked into the lobby there stood one of my deputies with several local police officers. Really, that isn’t something you want to see after working up a sweat and pushing your heart rate up. Particularly since I have often “preached” that you are born with only a certain number of heart beats, use them up and it’s on to death. When you see something like this you can kind of flash on one of those movies where the character out-of-bodies at death and sees folks coming for his mortal remains.

But they had not come for me. It was part of the investigation of an individual who had been pronounced dead at a local hospital. An acute myocardial infarction, 52 years old, continued inducement for my staying in shape (although his was not related to working out at the facility, he had stopped to use the public restroom).

Shocking Autopsy

My wife pointed out a game in a catalog that we got in the mail recently. Imagine the “Operation” game jazzed with the electrical genius of Tesla and you’ve apparently got this game, “Shocking Autopsy”. Like Operation you remove things with tweezers (9 mayhem causing implements), except in this one not only is there an annoying buzz but an electric shock as well.

I’d buy one for the office but I couldn’t play:
Caution: Use at your own risk. Not recommended for children under 14 years old, adults over 50 years old or persons with ANY medical conditions

Friday, August 24, 2007

Death by Suicide happens all too often

Posted at the American for Suicide Prevention website:
Hey guys, thanks for taking the time to come check out my fundraising page. In September of 2007, I plan on participating in an '"Out of the Darkness" community walk sponsored by the AFSP. Suicide prevention and awareness is an issue that is very dear to my heart. Having suffered from major depression and anxiety disorders since I was 13 years old, I know personally the pain and suffering that comes along with these diseases and others like them, that unfortunately end in suicide all too often. I have been affected by this tragedy as well, and know that suicide is something that changes your life forever and is something that you never get over. In May of 2006, I lost a good friend named Maribel Garcia to suicide. She was a beautiful, kind-hearted girl who had everything in the world going for her. She was kind, friendly to everybody, smart, athletic, artistically talented, and had the smile of an angel. Because of her battle with depression, however, she was the only one unable to see all these things that were so amazing about herself. A lot of people didn't see it coming at all, but of course in hindsight there are always signs you think you should have caught or things you could've done to prevent it. By that time though, it's too late and a lot of people learned that the hard way that day. Losing her was the most difficult thing I've gone through in my life, and I don't want anybody else to have to lose a loved one to suicide. That's why I will be walking in Maribel's memory, and I ask that if this is a cause that you also support, please consider donating to either myself or somebody else on Team Maribel. All proceeds will go directly to the American Foundation for Suicide Prevention. It doesn't matter how much you donate, anything and everything counts and will be greatly appreciated. Also, feel free to come out and support us at Busse Woods on 9/29/07. It would mean the world and more to me, and so many other people who have dealt with similar issues. Thanks for your time! ---Megan

On the Students Overcoming Suicide MySpace site:
Most of all…be kind to other people. You don’t know what they’re dealing with in their personal lives or the kind of hardships they’ve face in the past. You don’t know who’s about to be pushed over the edge. Maybe the quiet kid who sits in the corner in one of your classes is incredibly lonely, and thinking about ending his life. Just a hello or maybe sitting next to him could be the difference between life and death for him. Something as simple as holding a door, or just offering a smile, could mean the world to somebody who’s in a lot of pain. Be compassionate and don’t judge. Do the best you can to love yourself. If we can’t love ourselves, there’s no way we can truly love others, and we’re all we really have in this world. ---Megan

Her death by suicide occured a few weeks ago.

Megan offers some things that ought to be easy to do and maybe we can help lighten someone else’s load just a bit and make a real difference in their life with a simple kind gesture. I hope and pray we will.

Thursday, August 23, 2007

IL Child Death Review Teams

Illinois established multi-disciplinary and multi-agency Child Death Review Teams (CDRT) in 1995. They consist of a network of 9 regional teams with review and coordination by a statewide Executive Council. As related in their annual report, “in accordance with state statute this system reviews unexpected and unexplained deaths of children 17 years of age or younger”. Reviews target, in particular, deaths of children who are “known to the Department of Children and Family Services (DCFS)” as well as “the deaths of other children who died unexpectedly”.

As someone said, the CDRT system “serves as the voice of child death review in Illinois”. By means of case review and discussion utilizing a broad expertise brought by the team, recommendations are made regarding actions that might be taken to prevent similar deaths in the future. This will be particularly true with changes made with recent legislation. With its implementation not only will preventative recommendations be made to DCFS, but a new reporting mechanism is added to report to members of the state legislature for their review and possible action. I see this as a great addition to the effort to prevent childhood deaths; although there are a few other provisions in the legislation as passed for which I am waiting to see how the implementation goes.

I look forward to continued participation in this effort, 2 years on the regional level and now as a member of the Executive Council. I am a bit unique for them, because I bring not only my expertise as a Coroner, but also my years of Emergency Medicine experience, Primary Care experience, and years of experience doing child abuse and child sexual abuse evidentiary exams for the local Child Advocacy Center.

Wednesday, August 22, 2007

Help Shape the Future of Lake County’s (IL) Website

Have you ever visited Lake County’s website? We want to know what you think. You can participate in a unique opportunity to help shape the future of Lake County’s website. Our goal is to make it easier for citizens and customers to access services. Your input is extremely valuable. If you are interested in participating in a focus group, please email Lake County Communications at Participants are asked to commit no more than two hours of their time and will participate in a group question and answer session. The sessions will take place in early September and there will be day and evening sessions available. Participants will receive a thank you gift for volunteering their time. Lake County government welcomes and appreciates your input as we embark on this important project to improve access to County government through e-government services.

More deaths if flu overtaxes overcrowded ERs

I have written (in addition to my speech in Boston at the Association of Black Cardiologists meeting) before about ER care and overcrowding and its contribution to deaths. As I have said some real changes must take place or the problems will only get worse. I have, also, been in talks with a cardiologist with WomenHeart about putting together a national effort to do just that and look forward to that effort.

I came across an article today that drives home the need to address ER care issues sooner rather than later. It seems Australia is experiencing a particularly virulent flu season (theirs is opposite ours and possibly upside down). The incidence of the disease appears to be triple the previous year. This strain is making folks sicker and possibly has a higher death rate than with previous year’s strains and it is just the “usual” influenza A that occurs annually (not “bird flu” or anything exotic).

The biggest concern (not that the flu itself is not concerning) is that the illness is overwhelming their healthcare infrastructure. That sort of “pressure” will undoubtedly contribute to increases in other death categories. As we know, ERs are nearly at capacity on a good night, what with increased patient numbers, sicker people presenting, and full hospitals backlogging patients into the ER.

Will our next flu season (in a few months) be equal to Australia’s in severity? If so, we need to begin to address the problem now so that we have some plan to handle the limited resources that a serious flu epidemic will “test”. Let’s do it before we have anyone else die in a hospital ER waiting room (see also).

Monday, August 20, 2007

Prescription painkiller overuse can be a killer

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

An AP investigation found these reasons for the increase:
The population is getting older. As age increases, so does the need for pain medications.
Drugmakers have embarked on unprecedented marketing campaigns.
A major change in pain management philosophy is now in its third decade.

Consider (however):
More people are abusing prescription painkillers because the medications are more available. The vast majority of people with prescriptions use the drugs safely. But the number of emergency room visits from painkiller abuse has increased more than 160 percent since 1995, according to the government.

We have been seeing an increase in deaths related to prescription painkillers. Some of those individuals have died by suicide, but most are accidental deaths. These accidental deaths fall into several categories: partying/experimenting, self-medication gone awry, over-prescribing and misuse. The misuse can be on the part of the decedent or, miserable dictu, on the part of the prescribing physician.

I have no problem with prescribing pain meds when appropriate and in needed doses, I have in the past treated many individuals with severe acute and chronic pain, including those with severe AIDS-related neuropathy. It is critical, however, to know the meds you are prescribing: actions, interactions, side-effects, etc.

We have had a few cases lately that have revealed that some physicians prescribe this class of meds without knowing quite what they are doing. For example, fentanyl (not looked at in the AP article, but one we are seeing with increased frequency). Fentanyl delivered in a skin patch has a very long half-life causing it to build in the body, if not used properly, until toxic and potentially lethal levels occur. When we have discussed this with a few physicians we found that they were unaware of that possibility and of some other characteristics unique to this drug and delivery system.

We have seen over-prescribing by a very few physicians, cases we have reported to Professional Regulation and the DEA. We have seen individuals taking meds who apply the “rule” that if “one is good a few are even better” with disastrous results. We have seen folks not controlling the meds they bring into their homes, often not realizing just how deadly they can be if misused.

Control of painkiller misuse and abuse, as is true of several things I have brought up in this blog, will require “system” changes. Our office will continue to work to stop those few “bad apple” doctors abusing the system, harming or contributing to the deaths of individuals. Other doctors must be educated or educate themselves regarding the proper indications and use of these pain meds, as well as their possible interactions with other meds, their potential side-effects, actions, pharmacokinetics, etc. People need to be aware that these drugs have a potential for addiction and abuse just like that street drugs and should be treated with “respect”.

Pain meds are useful tools, but like any tool, when improperly used they can harm or kill.

Thursday, August 16, 2007

Beware web information sources

I was reading through a website recently: “The Writer’s Medical and Forensic Lab” and found it wanting (it is amazing what you can find when you wander the web). He holds himself out as an expert in Forensic Science and Medicine, and the purpose of at least a part of his website is answering questions from writers about death and medical issues for the things they are writing.

It is wanting because while his answers aren’t wrong the answers he offers are often not quite right or complete either. For example, in his answer to a question 3-14-07 about “psychological paralysis” he fails to mention that the definitive test to rule out extremity paralysis would be an EMG (electromyography), instead he states after ruling out head injury with various tests, “A psychiatrist would be brought in and the diagnosis would be made.” While that is likely when treatment would begin, it would not likely be how the “diagnosis” would be made.

In another answer (7-27-07) he states that the trachea and the larynx “could collapse and block the passage of air” when stuck though by a sharpened drum stick. Both of those structures are essentially rigid cartilaginous structures that can be fractured, crushed or lacerated, but they will not “collapse” due to a single sharp object transversing them.

I haven’t read this guy’s books, but I’d have to wonder how “good” they are. I do however like his last caveat on his home page:
The information found on this site is not to be used for any criminal activity or to bring harm to anyone.

Monday, August 13, 2007

Media face-time

I got a “message” recently passed to me through one of my Deputies from a local law enforcement official (kind-of reminds you of grade school doesn’t it). The message was (to paraphrase): You ought to come out when there is a high profile case, the media is there, when the previous Coroner was in office (meaning the longer serving individual in office prior to the one I was elected instead of) she would have been there.

I don’t do that and I will not do that. Going someplace related to a tragedy (that is after all the basis of the work of my office) just to get “camera time” is not my way of doing things. If a case that my office is involved in gets media attention and the media seeks me out or if there is a real reason to hold a press conference to get out information to all of the media at the same time and in the same way, I will participate.

I will respond to a scene from time to time, not with the intent to be seen, but with the intent to see and learn about the case, to participate in my office’s investigation. That is the way I plan to keep it. Even when I am not physically at the scene I am talking with my Deputy running our investigation on the scene, listening, discussing and consulting on the investigation. That is my role (much like when I was in the ER and paramedics were in the field under my direction and serving as an extension of “me” into the field).

I feel it is unfortunate that others don’t share my thoughts on this. I have seen officials arrive at scenes for the face-time. There are plenty of opportunities for me to work with the media without my seeking them out or seeking out “camera time”.

Thursday, August 09, 2007

Designated Drivers to Prevent Deaths

The DailyHerald has an editorial, “Message must get across to save lives”, written in response to a recent car crash in which the driver was over the legal limit of alcohol for driving in Illinois (the phrase often used: “legally drunk” is wrong in so many ways). The crash was horrific according to reports and people were killed.

They close with a fairly simple proposal that could do a lot to prevent alcohol-related crashes and deaths (although the first thought should likely be to not drink to excess/intoxication). There closing paragraph:
It brings us to a key point we want to stress at such a sad time: Several years ago, the concept of a designated driver became a popular message amongst law enforcement agencies and the alcohol industry itself. It is an easy and effective way to keep groups of partygoers safe. We encourage all people of legal drinking age to adopt such a routine when knowing ahead of time that there is a chance of consuming over the legal limit at a sports event, concert, party or festival. It is something that a true friend will do for others, and it will save lives.

To borrow from the Surgeon General’s statement regarding underage drinking (It is a truism that pertains to so many “problems”, although “problem” seems an understatement): “The solution is everyone’s responsibility”.

Tuesday, August 07, 2007

I hope for no more crashes

First, to the individual who left the voice mail at my office, I did get it (although it is not likely he reads my blog). It was a lovely piece of work filled with invectives and scatological references.

Second, all the results of my office investigations are public record, so releasing a blood alcohol result (I should note that the release is only in response to request of the media, not in some sort of preemptive release) is action in accordance with the law.

I rarely get vitriolic voice mail with the release of investigation results. Apparently only certain cases fall into categories which certain individuals feel should be protected from public view.

The results were not released to harm anyone or their family or to denigrate anyone’s contributions to the community. The facts are that a driver of a motorcycle had been drinking and had an elevated blood alcohol. Yes it is my opinion (in agreement with Illinois law) that he should not have been driving with that much alcohol in his system. [I knew the DuPage County Deputy State’s Attorney who recently died while driving intoxicated and feel that releasing the results in her case was also the right thing to do.]

While my caller said releasing the blood alcohol results should also be exempt because it was a single vehicle crash, it is only by the grace of God that that was the case. I drive the street on which the crash occurred, as does my family, people I know and people I do not know, and I thank God no on else was injured or involved. I say this not to demean the gentleman involved, I know he was a very good police officer and a beloved family man. I pray for him and his family.

The facts are what they are. I hope there will not be any more crashes, no more lives lost before they have reached their full potential, no more family and friends mourning the loss of a loved one. I hope…

[FYI: Officials: Alcohol Played Factor in Officer’s Crash]

Monday, August 06, 2007

Life after death

There was an interesting article in AARP The Magazine that I got the other day (yes, hard to believe, but I am over 50). It was titled "Life After Death” and was based on a survey of individuals over 50.

They found that 73% of the folks surveyed did indeed believe in a hereafter, with woman (80%) out-numbering men (64%) in that belief. Interestingly, but not surprisingly, two-thirds of the folks said that their belief in an afterlife has grown as they have aged. This seemed to be related both to exposure to others’ deaths as well as the feeling that they are getting closer to their own. Most folks’ view in the life hereafter is pretty conventional with heaven and hell being the destinations.

Interestingly, 88% of those surveyed felt they were going to heaven after death, but have a lower opinion of other folks, feeling that only 64% of others would be joining them in heaven. To me that doesn’t speak highly of how they view their fellow “man”. The other survey result that seemed to raise questions in my mind was that 23% of folks also said that they believe in reincarnation. Apparently there is an overlap of those believing in heaven and those that think they may be “coming back”. Maybe they are just keeping their options open.

The last bit that I wanted to mention was the pretty strong belief in ghosts and spirits with 60% of women and 44% of men expressing that belief. This belief was highest among 50-somethings (64%) and lowest among those 70 and older (38%). Quite interestingly, 38% of believers have their belief based on personal experience. For those who may be curious, yes I am among the believers in ghosts/spirits and, yes, based on personal experience both on the job and off (the house I lived in before my present one was particularly “visited”).

Thursday, August 02, 2007

Effect of Horror Movies?

I ran across an interesting article yesterday: “Science Uncovers What Literary Critics Have Always Known”. I agree with the point:
Horror movies appeal because humans like to feel grossed out and entertained pleasurably at the same time. There's a payoff in coexperiencing two conflicting emotions.

But I think the author glosses over a point made in the study that I think needs further examination:
They suggest that people who enjoy the yuck-yay feeling of horror movies are masters at psychological framing and distancing. Horror viewers who have the most fun are also the ones who are most convinced that what they're watching isn't real.

The study circumstances were quite artificial in at least one regard (the other being not using a more recent crop of horror films). The study subjects were repeatedly reminded that the movie characters were movie characters:
The researchers proved this point by showing people horror films alongside biographies of the actors playing the main characters, constantly reminding viewers that these were just movies and the “victims” were playing roles. Even viewers who normally avoid horror movies reported that they were a lot more comfortable and had some fun when they were reminded that the action was staged.

Do movie goers separate the fantasy as well under normal viewing conditions? Could not separating it as well contribute to less empathy and more desensitization to violence rained upon others? How would that translate into future actions in “the real world”? I don’t mean necessarily making them more violent toward others, although without further study I am not sure you can say one way or the other, but does it make us less empathetic or sympathetic toward others? Does it make us “numb” toward violence, less aware and more accepting? And, if so, what is that effect on society? Does it make them less “reachable” with “shock” messages based on avoidance of violence/injury?

That is the information I would like to see. It is my gut-feeling that these increasingly violent and disgustingly graphic (but not really realistic) movies have to be “bad” as a steady diet and maybe even if just consumed episodically.

Wednesday, August 01, 2007

Marin County (CA) pushes to prevent suicide deaths.

You know about an object that has contributed to over 1300 deaths during the past 70 years and have had a number of folks say that it is “fixable” so that most of those deaths will not occur there in the future. What do you do? Obfuscate and don’t talk about it, because it would involve saying a taboo word. Don’t talk about it because it would involve talking about suicide. It would involve admitting that death by suicide occurs there and we all know that the “law of contagion” would lead to increased numbers of deaths by suicide there.

Finally, the Medical Examiner of Marin County is pushing for something to be done:
"I'm tired of the carnage," he said. "The public needs to know these needless deaths continue at an alarming rate."
He also wants officials to erect a suicide barrier to prevent future deaths (on the Golden Gate Bridge).
"I believe a higher railing would stop a lot of the suicide attempts," Holmes said. "A lot of people go to the bridge really in the moment, rather than carrying through any well-thought-out effort to end their lives. Of course, you're not going to stop all of them. I'm not that idealistic."
Along the pedestrian walkway visited by millions of tourists each year, only a 4-foot-high railing separates visitors from the turbulent bay waters below.
"If that rail was just 6 foot tall, it would delete 75% of the suicides," he said. "Because now it is just too easy to kill yourself there. You don't even have to climb. You can just lean over the rail and go."

In office for “decades”, he has now taken a stand. He released data on the suicide deaths that have occurred off of the bridge during the last 10 years and is taking a leadership role in preventing them in the future. I applaud his speaking out about suicide and his efforts to prevent them.

Suicide should not be cloaked in taboo and stigma. Suicide happens more than most folks realize (57 deaths by suicide in our county last year). Certainly not all suicides are preventable, but we owe it to folks to try to prevent as many as we can. It is not an easy road to prevention, but we most definitely should go after those things that present an “easier” remedy and remediate them. Our Suicide Prevention Task Force keeps looking for those sorts of issues locally, as well as the tougher targets and solutions. Step one is getting folks more comfortable with talking about suicide, lessening the taboo and stigma.