Monday, June 30, 2008

Suicide is not chosen

Truism/quote from the final page of the 2007 Illinois Suicide Prevention Strategic Plan

“Suicide is not chosen; it occurs when pain exceeds resources for dealing with pain” Dr. David Conroy

Friday, June 27, 2008

“Good” Heroin v. Tainted Heroin Causing Deaths

As I mentioned in my talk the other day, the movie “American Gangster” among other things, shows what happens in an area (Harlem in the 70s) when the quality/purity of heroin improves. It is somewhat easy to miss, but before the consumer base stabilizes there are a number of addicts that die because they aren’t used to the less cut heroin suddenly available on the streets. They continue to use the amount of drug that they were using and it becomes an overdose before they realize it.

Something similar is apparently happening locally, as well as elsewhere in the country. We are seeing what looks like an increase in deaths due to heroin overdose (it is a bit early in the course to call it a trend, but it looks like it). Local law enforcement initially felt the deaths were due to “tainted” heroin, i.e. heroin cut/mixed with something that was causing the deaths in these folks. We have in the past seen fentanyl, a much more lethal drug, mixed in or replacing the heroin, causing similar deaths.

It was the opinion of my office that the deaths were more likely due to purer (“stronger”) heroin. Our toxicology testing has bourn that out. There is really good heroin on our streets.

I also warned the teens the other day that that purity also makes it more tempting to try this very addicting drug. You can snort it instead of using a needle. The numbers of those addicted will take longer to surface, but I suspect that that will grow as well with the increased purity. Teens, in particular, must be educated to not try the drug, their developing brains are even more susceptible to its addictive properties.

“Good” heroin is not a good thing. It contributes to all the problems inherent in the addicted population; physical problems, social problems, problems with the law. It contributes to death. Our tools consist of law enforcement, education and awareness, and treatment. All must be brought to bear on this problem.

Wednesday, June 25, 2008

Informative and Cautionary Coroner Talk

As I alluded to in my post yesterday, I spoke with a group of 40 students at Stevenson High School yesterday. I told them about what the Coroner and his “Office” does (in some detail, I had an hour and 15 minutes). Who we are in our office and what we do (often a bit more than is done in other coroner offices). I answered a number of questions. We discussed causes of death, manners of death (natural, accident, suicide, homicide and undetermined), ways of identification, post-mortem entomology, all manners of stuff “coroner”.

It was a bit tricky because the instructors had already written the test questions based on my talks the last 2 years and I don’t talk from notes, so I can’t necessarily guaranty repetition of all the material from one year to the next. I was prompted to cover an entomology point by a question from one of the instructors, so I must have got the other material, thankfully for the test-takers.

Most importantly, at times hopefully cleverly and at times blatantly, I peppered my talk (as I always do) with tips and reminders useful in their forestalling death. Honest warnings about drugs, recommendations about making good choices and not taking chances.

Interesting, informative, cautionary, I do my best. Besides, as I told them, giving those types talks are my favorite part of the job.

Tuesday, June 24, 2008

Are the dead too heavy?

What are we to do, our bariatric equipment is failing/breaking?

“Bariatric equipment”, in this case, is the fancy way to designate the heavier duty equipment we purchased to handle the heavier decedents we are tending to encounter. First our body lift, rated to handle 700 pounds, bent and the weld broke part way through lifting a female a few weeks ago (under warranty, so the company has replaced the damaged parts). Next our hydraulic morgue cart gave out under the strain of holding a large decedent (it was old anyway, so it was “retired”). Then last night our new transport cart (rated also at 700 pounds) broke while transporting another decedent to our van to bring him back to the office for autopsy. (It took 5 people to lift the decedent and the cart into the vehicle.)

Obesity is reaching (has reached) epidemic proportions. It is increasing the risk to my staff in lifting and moving folks. It is requiring heavy-duty equipment (that may not hold anyway). As I told a group of teenagers I gave a talk to today, do all you can to not get, or die, obese.

Friday, June 13, 2008

Death by Suicide or Lacking Access to Healthcaring?

(It is by intention that I wrote “healthcaring”. How caring is it that we allow so many people in our country to not have access to healthcare?)

How many more of these will we see? These words are from a suicide note left by an individual recently:

I didn’t call an ambulance because I’m not working any more and my insurance has run out.

My health has been getting worse and worse so this is not unexpected.

Please forgive any mess I leave behind.

It leaves me speechless.

Thursday, June 12, 2008

Co-sleeping can be deadly

A reminder that co-sleeping with an infant can be deadly:

…the cluster of deaths is reason enough for doctors and public-health officials to repeat their warnings about sharing a bed with young children.
"The best way to keep something from happening is not to do it in the first place," said Dr. William Cotton, president of the Ohio chapter of the American Academy of Pediatrics.
"The bottom line is, we suggest that you don't co-sleep."

Monday, June 09, 2008

I stand by my opinion, but will air others

I got a couple of these emails and while I stand by my opinion (as does a kayaker friend of mine) I thought I’d share these very good points with my readers. My job is to forestall death and my opinion and comment are to that goal:

Dr. Keller,

I am writing to you regarding the recent drowning of Ms. Connie Alton, the kayaker recently found on Lake Michigan, and specifically in regard to the statement attributed to you in the Daily Herald article, in which you are reported to have stated: "We've seen certainly more than one kayaker from Lake Michigan," Keller said. "With the conditions in that lake, it is certainly not a good place for kayaking." I am a paddlesports instructor, certified by the American Canoe Association, and serve on the Board of Directors of the Illinois Paddling Council, which is an umbrella organization of paddlesports clubs, retailers, providers, and individuals in the State of Illinois. At the IPC home page, you can find in the left margin, “Safety”, and under that “Lake Michigan,” where we describe many of the hazards & safety precautions necessary for safely paddling Lake Michigan.

Much has been made of Ms. Alton being an avid kayaker, who paddled Lake Michigan often. I won’t dispute that she may have been an avid paddler, but as a certified paddlesports instructor, I can tell you that “avid” does not necessarily translate into “skilled” or “knowledgeable.” I myself was an avid paddler for decades, before I learned how few skills I actually had.

(This) photo was taken from the Chicago Sun-Times web site.

There are many different kinds of kayak available for sale these days; each is designed for a different purpose. In the photo, it’s easy to see that this particular kayak is what we in paddlesports refer to as a “Recreational” kayak. It is designed for use on small, protected lakes, such as the lake at Independence Grove Forest Preserve, where the Lake County Forest Preserve District rents these kayaks to the general public. The LCFPD rental at that site is an appropriate use of this type of kayak, but this kayak was not designed for use in large bodies of water, like Lake Michigan. Experienced, knowledgeable paddlers know this. I would p osit that anyone who takes this type of kayak onto Lake Michigan is very unaware of the hazards to which they expose themselves (i.e., is both unknowledgeable and unskilled).

Another detail that illuminates this discrepancy is that she reportedly was not wearing her Personal Floatation Device (PFD, aka life vest). Experienced, knowledgeable paddlers always wear their PFDs, with the possible exception of what we call “pool sessions,” which are instructional events in very controlled, indoor pools, where multiple “safety boaters” and rescue-trained instructors are readily available.

There are other issues with this incident, which do not appear consistent with Ms. Alton being a knowledgeable or skilled paddler:

--I have seen no indication in the news articles that she had a companion along. Was she paddling alone? That’s never a good idea, especially on big water. A knowledgeable kayaker would typically paddle with a group of not less than three people, as a “safety net.”

--She was paddling on a foggy evening? This is never a good idea, as no other boat on the water will be able to see a kayak in fog. Knowledgeable paddlers are aware of this.

--The water temperature was around 50 degrees, which is cold enough to make somebody hypothermic in a very short time. A knowledgeable paddler would be wearing a dry suit, with multiple (not cotton) insulation layers inside it: He/she would be dressed for immersion in the water, not the air temperature. I don’t know what she was wearing at the time, but the answer to that question may shed additional light on Ms. Alton’s level of kayaking expertise.

I’m aware that Ms. Alton isn’t the first kayaker who has drowned in Lake Michigan; just last fall, one Mr. Doroba of Waukegan suffered a similar fate. A review of Coroner’s Office files should reveal if there have been others. As I recall, however, Mr. Doroba had just purchased his kayak, wasn’t wearing his PFD, and obviously had few, if any, of the appropriate skills for paddling Lake Michigan. I think it is also significant that neither of these victims were members of, or had any apparent contact with, any of the responsible paddlesports clubs that are organized in this area. Members of these clubs learn very quickly the limitations of their skills and equipment.

I will suggest that Lake Michigan is an excellent place for kayaking, provided the kayakers’ knowledge, skills, equipment, and experience are appropriate. In these two cases, the individuals’ knowledge, skills, equipment, and experience were clearly not adequate.

The point of this letter is not to highlight the probable shortcomings in these victims’ kayaking abilities. I do not, however, think it’s appropriate for a public official to be making uninformed and blanket statements to the media about the safety of kayaking on Lake Michigan. I’ll also note that many local jurisdictions, including the Lake County Forest Preserve District and many villages along the lakefront, support kayaking as a safe and ecologically friendly activity. That list of local jurisdictions also includes the US Navy, which provided the access for Ms. Alton to enjoy the lake.

Friday, June 06, 2008

With a little help from my friends

A couple of quick things that have crossed through my email;

If an individual is hit by a car and dies and that car leaves the scene (hit and run) it is a homicide (particularly in coroner’s parlance), but if an individual is hit by a car and the driver stays it is an accident.


NYC considers ‘organ-removal’ ambulance; Wagon would rush to scene of death, preserve body for transplant use

They got a federal grant to study if it would be workable to have a part of their city ambulance service be a quick response team to keep a body perfused so that organ procurement can take place.

Saving the living has always been the No. 1 priority for a New York City ambulance crew. But a select group of paramedics may soon have a different task altogether: saving the dead.
The city is considering creating a special ambulance whose crew would rush to collect the newly deceased and preserve the body so that the organs might be taken for transplant…

The transplant ambulance would turn up at the scene of a death mere minutes after regular paramedics ceased efforts to resuscitate a patient. The team would begin work almost immediately, administering drugs and performing chest compressions intended to keep the organs viable.

An interesting concept, but I don’t know that I would support it. As the article says it raises a “host of ethical questions”. And is to be limited to “cardiac arrest patients who die of natural causes”, but that is not always as evident as you might think at first review in the field. While I certainly support doing all we can to maximize the number of organs available for transplant. I am not sure this is the way to do it.

Tuesday, June 03, 2008

TV (no) credit

Small thing, but I wanted to mention that I was consulted by someone (I misplaced my notes on who I talked with) at Spike TV for what became "Way to Die #606" on "1000 Ways to Die" shown on May 31 at 10 pm. No credits, but it was good to see that it wasn't just someone looking for a creative way to kill someone.

Methadone for pain relief can be permanent

I was reading an article entitled “The Methadone Poisoning Epidemic” in The Forensic Examiner magazine (sorry no link, it was paper) and I wanted to share a few points with you.

Using information from a National Center for Health Statistics report the author relates that in 2003 methadone-related deaths rose 29%, while drug related deaths as a whole only increased 6%. In addition, methadone was responsible for more deaths than any single prescription painkiller listed (that doesn’t reflect our experience while we see these sorts of methadone overdose deaths, those with hydrocodone and oxycodone are in higher numbers here). The number of unique patient prescriptions for methadone increased 80% through 2005 and 2006 (in most cases prescribed for pain management).

The real key and the point the author really stresses is that methadone overdoses occur by in large in folks using methadone as a pain medicine, not in folks on methadone as maintenance therapy for opiate addiction. This is primarily because while the drug half life in the body is 24 to 36 hours, the pain relief effect lasts 4-6 hours. While the intent is to reach steady state for pain modulation, folks start chasing their pain with additional doses. Those additional doses build over time because of the long “real” half life with lethal consequences.

This lethality is compounded by concomitant use of other medications and certain underlying medical conditions, like sleep apnea and prolonged QT interval heart conduction problems.

Methadone is a dangerous drug for pain management and many don’t realize that (patients and doctors alike). It should be used with caution and only with a physician very familiar with the drug and with highly motivated and conscientious patients.