Driven to Distraction

Subject: Driven to Distraction video goes live; please share!

Good morning task force supporters,

Please take a few moments to watch our fantastic new YouTube video featuring Dr. Brian Johnston of Harborview.

Call to action: Watch this video and share it with as many friends, colleagues and groups as possible. To watch, please click on the front page of our web site, nodistractions.org" or go directly to the YouTube link which can be copied and pasted into your own e-mails:

http://www.youtube.com/watch?v=sjj2dLfeERE


Many wonderful people helped make this video possible, and we will be acknowledging each of them on our web site soon.


Thanks for spreading the word!

Lindsay Pease
Driven to Distraction Task Force of Washington State

Teen abuse of OTC and Rx meds

In the rush to worry about teen use of illicit drugs (not to belittle that action) we often lose sight of the fact that OTC and prescription drugs are used “nonmedically” more often than cocaine, heroin, ecstasy, and methamphetamines combined (SAMHSA data). Why?

Many teens think that these drugs are safe because they have legitimate uses and are often found at home in the medicine cabinet… Teenagers generally lack a sense that OTC and prescription medications can be dangerous or addictive… Some teenagers who abuse prescription medications and OTC preparations are sensation seekers, they "use" to get high, or are seeking to self-medicate. [from an article on Medscape, sorry no link]

Remember “Parents are the anti-drug”, but:

Parents may simply not be aware of the consequences of this type of abuse. Despite the increase in parent-teen discussions about the risks for drugs, many parents may not be discussing the risks of abusing prescription and OTC medicines with their children. Only 24% of teens have reported that their parents had talked with them about the dangers of abusing prescription drugs or the use of medications outside of a clinician's supervision, and just 18% of teens have indicated that their parents had discussed the risks of abusing OTC cough medicine [from an article on Medscape, sorry no link]

The key for parents:

The Partnership for a Drug-Free America recommends a 3-step approach: (1) educate [themselves about these and other teen “dangers”]; (2) communicate [with your preteen and teen, factually and repeatedly]; and (3) safeguard [limit access to what you must have in your home and get rid of the rest].

Shine a light on mental health needs

A while back I ran across an "article" by Glenn Close (sorry, lost the link) in which she wrote:

Even as the medicine and therapy for mental health disorders have made remarkable progress, the ancient social stigma of psychological illness remains largely intact. Families are loath to talk about it and, in movies and the media, stereotypes about the mentally ill still reign.

And

What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well…

She wrote this in support of a new website: BringChange2Mind.org. Every effort in this regard deserves support.

Mental illness does indeed not only affect the individual, but in so many ways affects all those around them. It is not something to be feared or ignored, but something to be treated and cared for.

Survivors of Suicide

We helped sponsor/host an event last Saturday giving folks whose loved ones have died by suicide an opportunity to view a program put together by the American Foundation for Suicide Prevention (AFSP). This is the third year we have done that. It is a great program (it will be available online, the AFSP website, through the year), well worth looking at. The program as always was thought provoking and emotion provoking, as well as filled with great information and support for folks who have had loved ones die by suicide.

One item that jumped out for me this year was a recommendation on how to help with someone who is grieving. It was summed up as: Hug, Hush, and Hangout. Be there for the person you want to help through their grief, listen instead of offering your thoughts, and give them a hug. What an excellent way to really help them.

Someone else on the broadcast mentioned doing the dishes for them as well. Not a bad idea either.

More on the health food that tastes good

A study out of the Nestle Research Center in Switzerland (no chance of conflict of interest there) demonstrated that 1.4 ounces of dark chocolate a day lowered the amount of stress hormones in folks’ blood streams, presumably reflecting reduced body reaction to life stress. A good thing.

Previous studies have demonstrated that dark chocolate is cardioprotective and I have mentioned that research in previous blogs. So, finally a health food that tastes good and appeals to the masses. Eat (remember, all things in moderation) live long and be healthy.

Just saw this and thought I'd add it: How to pick healthy chocolate

Coroner Hauntings?

In case you missed it in the Tribune:

"Eerie events rattle those in the coroner's office"

Photo Post: Swine flu fears

Writing and Arithmetic

Last night I was invited to the ITT Technical Institute Program Advisory Committee meeting, sitting with advisors and the program chairman for their School of Criminal Justice. It was an interesting experience. There were representatives from the Department of Homeland Security, Cook County Probation, and a private security company at our table for the discussion.

While the chairperson did discuss the program as it is and what sets it apart from other criminal justice programs, the bulk of the information being sought may be surprising: stuff regarding writing and math skills. I have said it before (somewhere in this blog) and in response to questions of what an investigator needs to work in our field (the Coroner business), communication skills (written and verbal) and at least some basic math skills are of critical importance.

The chairperson was looking for ways to “test” writing skills and input into how math is used in our fields as a tool in teaching math skills. Hopefully we gave him at least some usable stuff to pass on to the instructors. It is great to see that that is a focus of his program. While it isn’t as glamorous as the stuff you see on TV, the ability to write (communicate) and do relatively common math “problems” is critical to working effectively in the Coroner’s business, criminal justice, and, quite frankly, just about any walk of life.

No colonics

Now here is something you don’t see talked about every day:

I had someone come to the office a while back seeking my advice. He had seen all the ads and products for colon cleansing (there are an amazing number) and someone told him that it was a great and health producing procedure and that it was necessary to get out all the stuff we carry inside all our lives. He asked if, indeed, people carried 15 to 25 pounds of meat or other food byproducts (s**t) in their colons.

NO

In all the autopsies I have observed, surgeries I have observed, and lessons I learned in Med School, there has never been “stuff” “stuck like spackle” on the inside of someone’s colon. While an enema may be occasionally needed for acute constipation there is no other health benefit or health need for colon cleansing. Don’t be duped into buying into that foolishness.

Coroner’s Suicide Thought Piece

One in 5 or 6 people are touched by or are close to someone who has died by suicide or will die by suicide. That is a huge number. As they say, a sobering thought.

I have been “touched” by suicide in the past and continue to be brushed. This Friday I will be attending a workshop for Counseling Professionals regarding suicide prevention. More personally, I have had even closer brushes recently.

I was recently in a conversation about someone we knew who was thinking of traveling to Switzerland, where suicide is legal, as a place to die by suicide. As a matter of fact, I had just run across an article on the internet, just that day, about that fact about Switzerland. Apparently, a fair number of folks travel there with suicide on their mind. More to the point of this post, should I intervene? The individual is elderly, feel that they have lived a full life and fear that they will become a burden as they age further and develop more severe medical problems. Beyond trying to keep them aware of all the reasons life is worth living and the distinct possibility that they won’t become a burden, do I force my value system on them? Are they wrong to chose an end with a view of the Alps?

“Brush” number two: A dear friend of mine has serious fears that a mutual friend is or has contemplated taking their own life. They feel that because of a hurricane of stress that will be a choice that that person will make. There are risk factors, but that person has shown resilience in the past. They have a support system readily available. I feel that in this case the positives outweigh the negatives. But who can really predict what will happen? Certainly we have seen a number of folks who have died by suicide who had friends and family who felt the same way about them. Of the future, we can see only the possibilities.

Another brush is a young person. The darkness always seems immense and seems as if it will last forever. It is critical to work to help, to get them help as is appropriate. Expand their knowledge of available options, watch for impulses. Teach them resilience, the ability to work through it. Teach them that the darkness will not last forever, that they can get through the darkness, that there are other possibilities. Life is worth living, there is so much potential in each and every life.

Anti-cocaine vaccine?

Interesting, but I’m not sure how much “promise” this experimental treatment really shows: Cocaine vaccine shows promise for recovering addicts

… a new cocaine vaccine… the vaccine reduces use of the drug by raising anti-cocaine antibody levels in the blood, thereby inactivating the cocaine before it enters the brain and gives the user a high

However, the article goes on to say that the antibodies reached effective levels in only 38% of folks treated and they are only present about 2 months after getting the shot. Multiple vaccinations would be required.

Certainly this kind of treatment needs to be investigated, but don’t expect to see it out as an effective treatment any time soon. Although, it would be great if it could be boosted for improved effectiveness and long-term studies show “promise” as well.

Grief normal or too much

Grief does have it purpose, adjusting to the change in your life and dealing with your loss. We deal with grieving folks all the time and not just at the time of the death of their loved one, but often for weeks (and occasionally longer) after that.

Each of the 2.5 million annual deaths in the United States directly affects four other people, on average. For most of these people, the suffering is finite — painful and lasting, of course, but not so disabling…
For some people, however — an estimated 15 percent of the bereaved population, or more than a million people a year — grieving becomes …“a loop of suffering.” … “It takes a person away from humanity,” she said of their suffering, “and has no redemptive value.”
This extreme form of grieving, called complicated grief or prolonged grief disorder…

Those that do become debilitated by their grief, locked into that loop, do need professional help. They need to develop the tools in their psyche, in their lives, to deal with something that will not go away, but that can be dealt with. They may need to be nudged or pushed in that direction.

Grief is normal. You don’t get over it. But you can not let it take over your life to the point there is nothing else.

Zombie warning

Got this on a listserv and I don't see a copyright mark

Bullet shortage

Do you realize that this is affecting law enforcement agencies?

Shooting ranges, gun dealers and bullet manufacturers say they have never seen such shortages. Bullets, especially for handguns, have been scarce for months because gun enthusiasts are stocking up on ammo…

We have seen it, too.

My deputies do carry handguns (Coroner’s deputies in this county have carried at least since 1991). We do respond to somewhat risky neighborhoods at risky times in the immediate aftermath of violence or when violence may erupt for other reasons. (Deputies also wear ballistic vests) This shortage results in increases in the cost of ammunition and makes finding available sources more difficult.

Just a note about something else folks may not think about when they are pondering what the Coroner’s Office does.

I agree with the author that this trend is scary and a sad commentary on our society, as well.

Interesting Week for Coroner, Never Routine

It was an interesting week of meetings.

Tuesday I presented my 2010 budget to the County Board committees that need to approve it before it goes to the full Board. To meet county targets set because of projected county income short-falls, I had to make some cuts. It was tough to do because we have been running a pretty lean budget since I set my first one after taking office. I am pretty sure we will accomplish this expense reduction without forcing my deputies to use only one glove per case. Actually, despite already submitting my budget I have some other cost saving ideas that I have mentioned to the county Finance folks. We will see how they pan out. Then there is also my reserve plan to sell Coroner Office T-shirts, etc as a revenue enhancement.

Yesterday I went to a meeting to discuss a way to expand access to healthcare for uninsured folks here in Lake County. It was an interesting discussion on trying to port/modify a system in DuPage County to ours (the discussion continues). This is important because, as I have mentioned before, folks are dying from lack of insurance. This is a project I helped explore a few years ago, I am glad it has come up again. Not that I don’t trust changes occurring on a national level, but I don’t trust changes occurring on a national level.

Today I spoke to a group of 80 senior men (one guy was celebrating his 91st birthday). Who would have guessed that they would love the story about a case we investigated complete with the discussion of decomp odor, skeletalization, maggots on crack, and a blender rendering of those maggots for toxicology testing. I know the teens I talk to enjoy it, so I thought I’d try it on this audience. It was fun for me and I hope informative for them.

Oh sure there were death investigations, discussions of death investigations, media calls, and other routine things happening as well, but it is always the other stuff that moves the week along.

Level I Challenge for Coroner’s Office

We were already on track for a significant increase in the number of deaths in Lake County that involve Coroner office investigation (approximately 15%) this year. Most deaths (about 80%) require little or no investigation, e.g. hospice deaths, natural deaths from normal disease processes.

Then came the news that a local hospital will begin operating as a Level I Trauma Center October 1st. We knew it was coming, but couldn’t get concrete numbers on how many individuals (victims of trauma) that are currently flown out of our county would now be staying for treatment and potentially dying in county. The folks that are flown out are the most severely injured and unfortunately many succumb to their injuries despite the best care possible.

Now we know that the hospital projects that about 300 folks currently flown out will be going to their hospital for care. It must be an incredible undertaking on their part to prepare for that caring and that rather precipitous jump in treatment volume. But no one consulted us on how that will impact our functioning; apparently they felt we would just take up the potential jump in case volume. I’ve already submitted my budget for 2010 and it includes cuts because of concern for Lake County’s limited resources projected by County administration, not service expansion possibly mandated by this change in the county milieu.

I don’t mean to sound cold about these individuals dying, but the reality is that these things must be thought about as well. These deaths will challenge our resources, staffing, autopsy services, and toxicology testing. Planning is difficult because we don’t know how many more deaths will need investigation or what will be necessary in our death investigations for these individuals. For example, will they have had enough testing (x-ray, CT, MRI, toxicology) during their in-hospital care to preclude the need for autopsy?

These are interesting times and our personnel will rise to the challenge, but a bit of number projection and information about possible cases would have been nice.

Food for Misdirection of Thought

(Note: I had thought of this post before I ran across the article that prompted the above post. It became an interesting juxtaposition.)

I often get asked what we in the Coroner’s office do to decompress, to get our minds off the death we deal with all the time.

One of the things we do is participate in what I jokingly refer to as “food porn”. Not “porn” in the usually thought-of context, but reveling in the earthly delight of food. If you have ever watched some of the photography of food shows (and even food ads), you can see the visual quality they often strive for. Actually some of that photography comes pretty close to a porn presentation. I am also not referring to gluttony either. I think of that more in the sense of mass quantity consumption with “vomitoriae” (or is it vomitorii?). Again, some of the shows on TV do seem to cross that line, but we prefer a less gross presentation (although we sometimes catch a bit of Andrew Zimmern for grossness). Also our tastes do not run toward haute cuisine, but more the burgers, BBQ, and bacon sort of food selections.

We enjoy watching Anthony Bourdain during lunch while making multiple comments about his food exploits and the attractiveness, to us, of the food he is sampling. We also trade stories and recommendations about local, and not so local, eateries and food options. We trade web-based food information, like the recently circulated “squeezable bacon” ad and a recent article about potentially deadly fast food.

It’s fun, it’s something else to think about and sometimes it’s a tip that leads to a nice night out with the family.

16 year-old's death with hot dog

Now this is a pretty unusual occurrence, but I thought it might be worth a caution. Kids do choke on food, as do folks on the other end of the age spectrum, with hot dogs being high on the list (I remember during my ER days, pulling a gumball out of a young child’s larynx just in time). But it is pretty unusual to see this in a healthy teen.

An autopsy report on a 16-year-old Spartanburg boy came with a warning from the Cherokee County coroner. "Hot dogs are a choking hazard and should be consumed carefully,” he said
… died as a result of a hot dog lodging in his throat.
Friends at a youth group pool party tried the Heimlich maneuver but it failed.

With all the foody shows on TV showing folks wolfing their food, it behooves us to remind young people that it is important, and potentially life saving, to chew well when eating.

Suicide Prevention Week

Next week is “National Suicide Prevention Week” so I thought I’d post the “Suicide Warning Signs” from SAMHSA.

Last year Lake County had 67 individuals die by suicide (up 46% from the year before) and this year looks to be in the same range as 2008.

For folks that you think might be at risk of taking their own life, talk to them, suggest help, push them to get help. That will not push them toward suicide, but may help them to see that there are other options. Empathy expressed can be a useful tool to prevent suicide.

Seek help as soon as possible by contacting a mental health professional or by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) if you or someone you know exhibits any of the following signs:

Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself

Looking for ways to kill oneself by seeking access to firearms, available pills, or other means

Talking or writing about death, dying, or suicide when these actions are out of the ordinary for the person

Feeling hopeless

Feeling rage or uncontrolled anger or seeking revenge

Acting reckless or engaging in risky activities—seemingly without thinking

Feeling trapped—like there’s no way out

Increasing alcohol or drug use

Withdrawing from friends, family, and society

Feeling anxious, agitated, or unable to sleep or sleeping all the time

Experiencing dramatic mood changes

Seeing no reason for living or having no sense of purpose in life

Nitrous Oxide Abuse

It is easy to lose sight of the real dangers of inhalant abuse with all our focus on the growing problems of illicit and licit drug abuse so obviously going on around us. Abuse of inhalants can be a cause of death in young people. We need to keep that in mind and make certain that it gets mentioned in our efforts to keep young people drug-free, alive and well.

“A study by the Partnership for a Drug-Free America indicated that nearly 4 of every 10 parents are not aware of the risks of inhalant abuse. Information on this important topic needs to be distributed both via the media and during parent programs in the schools.”

I mention this because we were recently reminded of the abuse potential and the potential for harm with nitrous oxide abuse.

“…abuse of nitrous oxide is no laughing matter.”

“[However] few students (in this study) were aware of the potential acute or chronic ill effects from the use of nitrous oxide”

Talk about your “fun” intoxicant: “Inhaling nitrous oxide produces a brief euphoric "high" caused by oxygen deprivation.”

“Asphyxiation takes place when nitrous oxide depletes the oxygen supply to the body because too much of the inhalant is in the lungs. If inhalation continues, a person will die…”

As the article ends:

“While there is no easy solution to the problem of drug experimentation among youth, encouraging and assisting parents to become informed participants in raising drug-free children is an excellent beginning.

Let's make sure our community and schools continue to allocate sufficient resources -- financial, personnel and curricular -- to achieving this goal.”

"Informed participants" is a very important aspect, as is ensuring broad prevention programming. Substance abuse is not a focused problem and programming to prevent it must be broad-based.

Lake County 2007-2008 Drug Fatalities Map

Lake County 2007-2008 Drug Fatalities Map

Other maps (see below) a slow process for web-readiness due to budget constraints

Mapping Coroner Data

Our office almost seems awash in County maps. Maybe awash is hyperbole, but how often do you get to use words like that. Actually we have 4 large (like 3 X 4) maps, not counting our even bigger detailed map of the county. The reason for the 4 maps is that sometimes is “better” to look at something graphically than just numbers and letters on a sheet of paper or computer screen.

We started with one plotting the locations of illicit drug overdose deaths (primarily those involving cocaine and heroin). We have 3 years of data on one map and another with stick pins for this year as we add deaths. It is interesting to see the dispersion across the county of these cases. They aren’t in just the “bad neighborhoods” (I live in Waukegan, considered by many as one of those “bad neighborhoods”), but also in many affluent areas of the county. Free time and disposable income are contributing factors.

The other 2 maps were projects we gave our interns with 4 years of data on each. One map is violent deaths, gun-related and other homicides, along with house fire deaths. The other has car crashes and train related deaths. The violent deaths do clump more in certain communities verifying what most folks would suspect, but it is interesting to see it mapped. The car crash map tells us that there are no particularly fatal intersections or stretches of road that we ought to push to fix.

I think it is interesting stuff and a nice way to get a handle on a bit of the information that flows through the Coroner’s Office.

Quotes about kids (link sent by a friend):

Children have never been very good at listening to their elders, but they have never failed to imitate them.
James Baldwin

Your children will see what you're all about by what you live rather than what you say.
Dr. Wayne Dyer

Driving Distracted Kills

Report that could have saved lives is buried for 7 years, holy mackerel.

… cellphone use behind the wheel "has contributed to an increasing number of crashes, injuries and fatalities."

… a problem that could be as bad as drunk driving…

We have seen car crash deaths in which the driver’s cell phone “rang” moments before the crash and likely contributed to the crash. It is a little harder to check to see if they had dialed out, but no doubt there were some of those as well.

Driving distracted is deadly and it is great to finally have the data to prove that released. At the very least, the dangers of driving distracted need to be taught to teens in tandem with the dangers of driving intoxicated from whatever source. Parents need to warn their kids. PSAs (do they do PSAs anymore?) need to heat the airwaves. It is a real threat to the lives of folks in cars. And I think particularly the young, just based on their volume of phone use.

IL HB 497 (awaiting Governor’s signature)

Synopsis As Introduced
Amends the Alcoholism and Other Drug Abuse and Dependency Act. Provides that the Director of the Division of Alcoholism and Substance Abuse within the Department of Human Services may publish an annual report on statewide drug overdose trends, may establish a program to provide for the publication of drug overdose prevention, recognition, and response literature, may provide advice to State and local officials concerning drug overdose problems, and may award grants to create or support local drug overdose prevention, recognition, and response projects. Requires a health care professional prescribing an opioid antidote to a patient to ensure that the patient receives certain patient information; provides for immunity from disciplinary or other adverse administrative action; and provides for administration of an opioid antidote in an emergency. Requires the Director of the Division of Alcoholism and Substance Abuse, in consultation with statewide organizations, to develop and disseminate to health care professionals, community-based organizations, substance abuse programs, and other organizations training materials in video, electronic, or other formats to facilitate the provision of the required patient information. Effective January 1, 2010.

I think it is great that this bill passed and I hope the Governor signs it to move it along. It will need to go to another governmental committee (I forget the name) where they flesh out the details and hopefully that will go well.

It will be good for everyone to be aware of statewide (and, I hope, regional) trends pertaining to drug overdose. I also hope that the reporting will include information on the nonfatal overdoses. It will be easier to target prevention and intervention based on real data.

In addition to that, making Narcan available in the community (with education and training in its use for emergencies) will undoubtedly save lives.

I look forward to the implementation of this new law and we can join some other states in these prevention efforts.

Hopeless teens, self-fulfilling prophesy

Talk about an OMG moment. I first heard about this on the radio this morning, and then I came across this article:

A surprising number of teenagers -- nearly 15 percent -- think they're going to die young, leading many to drug use, suicide attempts and other unsafe behavior, new research suggests.

…a sizable number of teens may take chances "because they feel hopeless and figure that not much is at stake,"…

I still need to track down the study, but I would rate this as one of the most upsetting study findings I have come across in some time.

Where do these teens get this message? What can we do to give them the information/knowledge that that is in fact not the truth? If this is a prime motivator behind substance abuse, violent behavior and risk taking in this number of teens, we need to have a new focus in dealing with these kids. How do we affect behavior that has this type of an underpinning?

Married to dope

My wife got a book recently that she said I should take a look at. It is “Esquire Presents: What It Feels Like:…” by AJ Jacobs. It is an interesting, quick read with short essays on things like what it is like to be gored by a bull or survive a hurricane. I wanted to share one bit from “What It Feels Like To Do Heroin”. I share this so that it can inspire parents, schools, and other groups to push primary prevention; to work hard to prevent that first use. So that people ensure access to secondary prevention (treatment) and, maybe, reduce a bit of the stigma of seeking help and the stigma attached to those people who become users:

Everybody looks at you with reproach…you are married to dope. It’s more than half your life. It is your life. All you want is to be high. And if you are sick, all you want is to get right. It all comes down to one thing: The first time you did heroin you felt better than you’d ever felt in your entire life.” (David “Wilson”, 41, former addict)

This essay is about heroin, but it equally applies to prescription pain meds and any number of other addictive drugs.

I am reading a report on the growing crisis with prescription drug overdoses, more on that later.

Healthier Community

I went to a presentation by Dr. James Galloway the other day. It was in support of a pilot program in Chicago to “Build a Healthier Chicago”. Their website is worth a visit.

They are working to develop plans to improve the “pre-medical” parts of our healthcare crisis, as well as working with the more traditional outlets of medical care. They feel that our current situation can be summed up:

Physical activity (lack of), nutrition (unhealthy), and smoking are the three most important areas to target to improve the health of our nation.

I applaud their efforts and it would be great to bring a similar effort here and across the country.

The idea that individual health choices and personal behaviors are the most important determinants of chronic disease is an idea whose time has come…(George Menasah, MD)

But while individual choices are important:

…it is unlikely that individually attempted changes in lifestyles and behaviors alone can avert the growing epidemic of chronic disease that we are witnessing.

As long as a burger and fries are cheaper and more accessible than fruits and vegetables, as long as kids’ brains are bathed with seductive media blitzing in support of unhealthy diet and activity choices, as long as the community does not value and encourage healthier lifestyles, they will not happen. We need a community effort for a healthier community. We need to change our social norms to support/encourage a healthier (and safer) community.

"No one deserves to die by overdose"

…deaths from drug overdoses have been rising and have reached crisis levels in our country. A newly-released report by the Drug Policy Alliance documents the extent of the problem: drug overdose is now the second-leading cause of accidental death in America, surpassing firearms-related deaths. And it's not just young people who are dying of overdoses: overdose is the number-one injury-related killer among adults aged 35-54.

This is true not only with illicit drugs but also with the misuse, overuse and abuse of prescription drugs.

But efforts to implement … solutions are hamstrung by a drug-war mentality in which there are "good" drugs and "bad" drugs and, by extension, good drug users and bad drug users, the latter seen as somehow deserving of death when they overdose. No one deserves to die by overdose. Everyone deserves a second chance at life, and to be treated compassionately …
We need to accept the reality that people will always use drugs, whether legal or illegal, prescribed or sold on the street, mood or performance enhancers, pain killers or stress reducers or sleep-enablers. We are a nation of drug users. We must learn how to reduce the harms associated with our drug use, including reducing the unconscionable and unnecessary number of deaths from overdose.

We must address this problem in new ways. Not just law enforcement, although that is critical, but with well thought out plans and programs. We must use every piece of information that we can access to tackle this crisis. Education, primary prevention before folks use, secondary prevention to prevent relapse and reuse, making a wide variety of treatment available because there is no a one size fits all solution. We must work together, because this is not their problem, it is not my problem, it is our problem. People shouldn't feel as if their toes are getting stepped on or they are being upstaged by someone "out of the box" before they are. There is plenty of work to go around and we all have to work together to get this work done.

Where death delights to help the living

I like this line (it came to me on a listserv; sorry, I wrote it down without the name of person who contributed it and I don’t believe they cited the author), unfortunately the Latin line looks to be a bit long to put over the door to our office building (would be cool though):

Hic locus est ubi mors gaudet succurrere vitae

This is the place where death delights to help the living

Healing Community Problems

I was listening to a radio program a few weeks ago (At Issue on WBBM, no link). The folks being interviewed represented a few anti-violence programs in Chicago and had several interesting points. One of the things someone brought up was a list of 3 things that interfere with finding and applying solutions to problems, community problems in particular. I think the list is applicable to a number of problems, not just violence, so I thought I’d put them in here:

First, people won’t work to solve a problem that they don’t think affects them, that they don’t think is theirs. If you see a problem as someone else’s or can convince yourself that it is the other guy’s problem, you think they should work on the solution. I don’t have to; it is your problem you fix it.

Second, people don’t care about the problem. Granted a number of folks just don’t care about much of anything, but his doesn’t mean they are all uncaring people. Many have enough other problems that they don’t have room on their plate for something else to “care about”. When you are scrambling to get food on the table and a roof over your head, you may not “care” about violence outside your house.

Third, if people do not know what works they get overwhelmed thinking of or trying a solution and may quit. We need to put proof that there are solutions that work in the hands of the folks who can and will work toward a solution. The proof must be real and fact-based, not anecdotal. In the case of community violence, there is very good evidence that CeaseFire and it violence interrupters and other interventions work and should be in widespread usage.

To get the community together on working to address/solve community problems we must show them that it affects them, tell them why they should care, and show them what works for a solution. We can work together for community solutions and community healing of a wide range of problems. Community problems can only be solved on a community basis.

Not that it has a much to do with the forgoing, but I have been wanting to share a quote I caught from Bill Murray on TV a while back:

It is not about doing the right thing; it is about doing the next thing right.

Substance Abuse Treament Clinic

I sent this out as a media release, from me personally, yesterday and I thought I'd also share it here:

I am the Lake County Coroner. I am also a husband and a parent. I spend some of my free time as the Medical Director of a new substance abuse treatment clinic in Waukegan, by the name of Green Dragonfly.

I agreed to serve as the Medical Director for a number of reasons. Drug overdose is the number one cause of "unnatural" deaths in Lake County. Something needed to be done. The aunt (Mary) of a 25 year old who died of an overdose while on the waiting list for a local treatment program demanded it. The son of an elderly woman who had become dependent (doctor talk for addicted) on pain medications because of inappropriate over-prescribing by her doctor sent me an email in July 2007 asking me where he could take her for treatment. I didn't know. Opiate-related (heroin and prescription drugs) deaths more than tripled 2007 to 2008 and continue high in 2009.

Green Dragonfly opened in October 2008, currently has 92 patients and continues to grow. Mary (mentioned above) put the clinic together and continues as its Office Manager. She asked for my help and I agreed. More than one third of the patients are being treated for addiction to prescription pain medicines or their addiction started with prescription meds. 60% are employed in a variety of jobs while in treatment. The patients live though out Lake County, in McHenry and Kenosha Counties.

Being in treatment helps these people stabilize their lives. People are less likely to break the law. People can be more productive, contributing members of society. Treatment restores them, improves their lives and improves our community.

This substance abuse epidemic must be attacked with prevention, education, and increasing the likelihood that someone who abuses drugs gets treatment by increasing the availability of treatment and eliminating the stigma of seeking help and getting treatment. I want to be able to tell the 6 mothers of children who have had recent overdose deaths that we are doing everything we can to try and prevent a 7th from joining their group.

Drug Info for Parents

A freind of mine sent me a link to this and now i share it with you (I haven't read the whole thing, so I do not vouch for the information, but it seems helpful through the part I have read):

A Guide for Parents to Educate Themselves About Drugs Before Educating Their Kids

...if you are a parent, sometimes saying “stay away from drugs, they are bad for you”, isn’t good enough...

How do you explain to them all of the drugs that are out there and why they are dangerous and what they could do to you if you take them? Here is a list of drugs that every child should be aware of. It may be lengthy, and going over all this information with your children could take a while, but you have to remember that it is for their benefit as well as you, the worried parent.

They are us

I participated in a town hall meeting last evening about an apparent increase in drug use and drug-related deaths locally. One thing (among many) got me thinking afterwards. A couple of the presenters pushed the point that the young people who have died or otherwise used and abused drugs (heroin being a primary focus of the event) bought the drugs outside the area they lived in. This is not really true according to our investigations and other information sources, but that is the story they pushed. I made the point that these young people (the audience being primarily parents) are, quite often, getting their drugs in their own neighborhoods. Sure, before they are resold here someone gets them in Chicago or Milwaukee, but the end users can and do get the drugs close to home.

One speaker described how dangerous and scary the places where drugs are sold are. How his agents, when they do drug buys, have 4 back-ups watching over them to help if the need arises. How violence can erupt at any time. (Although it seems to me that they are the police and their buying introduces variables that do not exist in the more typical drug buy.) I know some of these places are rough and potentially dangerous, like places on the west side of Chicago. But to painting them so ominously, so evil, particularly areas near where I live (North Chicago and Waukegan were specifically mentioned) does seem a bit melodramatic (for crying out loud, I live in Waukegan with my family). Realize that nearly all drug buys go off without a hitch or we would have dead addicts littering our streets.

My thought here is that this smacks of feeling the need to paint these folks as the other, the evil other. Demonize them and we don’t really have to deal with them. They are outside our communities. They live and do evil things elsewhere. Our community is safe. It (the bad stuff) is only outside our community. Sure sometimes it creeps in and affects one of our own. But it is not us, it is them. It is evil contagion from outside. We don’t have to deal with the ickiness, just continue to buff up our stuff.

One of the points I hope I made was that young people are getting the drugs, quite often, near home. The drug sellers are often “us”. The drug users and abusers are “us”. They are among us. Very often you can’t tell by looking at them. They work in our stores and restaurants. They walk by us on the streets and go to school with our kids. They aren’t fiends. They don’t look like the alleged meth user pictures on the Internet that one of the presenters showed.

We as a community need to respond to saves others in our community. Our focus must be more than arrest and imprison. We must make sure help and treatment is available. We must get rid of the stigma and shame that often accompanies seeking and getting help for drug use or mental health issues. “They” are not “others”, they are “us”.

Prescritpion Drug Abuse

Some highlights from the National Prescription Drug Threat Assessment 2009:

When abused, not only are these drugs dangerous in their own right, they often lead to the use of harder drugs, with life-altering consequences.

Diversion and abuse of prescription drugs are a threat to our public health and safety--similar to the threat posed by illicit drugs such as heroin and cocaine," said Director Kerlikowske. "In 2006, the last year for which data are available, drug-induced deaths in the United States exceeded firearm-injury deaths and ranked second only to motor vehicle accidents as a cause of accidental death.

Friends or relatives are the primary sources for CPDs [controlled prescription drugs] among most abusers…Teenagers find diverted CPDs readily available.

CPD abuse is most prevalent among young adults.

This certainly coincides with our experience with increasing numbers of prescription drug deaths that we rule accidental, i.e. not suicide, just folks using, overusing and abusing prescription drugs.

One death affects so many

I was sent a copy of an article that appeared in a local paper (I don’t have a link). The article title and the fact that I have a couple of pre-prom events later this week got me thinking and writing.

The article’s title (actually a guest essay/opinion) was “A child’s death is just one effect of underage drinking” and it covers other effects of alcohol on adolescents similar to stuff I have written about before. The tangent my brain went off on, however, was the effect the death had on those connected to the teen who dies and/or the people that are affected by the death.

The teen that died and the potential lost. What or who could they have affected through their life? What relationships never formed? What discoveries would have been made? That potential never realized, at what cost and to what effect?

The death will have deep and permanent effects on the teen’s family and friends. It will have effects on everyone that those folks relate to and come into contact with, likely throughout their lives. There will be effects even on folks only peripherally “related” to the teen that dies. Effects on others at their school who may not have known them, but hear of the death, folks at their church, like a pebble into water the waves propagate outward.

Folks previously affected by death may have ‘old wounds’ reopened or at least disturbed, even folks who may just hear about it in the news. Again propagating waves.

Those that respond to the scene of the death and those that may work to save them pre-hospital and in the ER will be affected. We all like to think we are stoic and unaffected, but these deaths affect even the most seasoned.

For others injured in the incident, each would have their own cascade of affected folks. Pebbles into the water.

Lastly, you always have to have an “other” category.

One death affects so many.

Can driving distracted = reckless homicide?

There was apparently a report on the radio earlier today (I didn’t hear it, but one of my employees let me know) referring to a recent death in our county. I had a bit about it earlier this week in a post. There is also a listener poll on the WGN website pertaining to the death asking if a death caused by a distracted driver should be pursued as reckless homicide? From what I heard, our State’s Attorney has decided “no”, at least in this case.

We have not yet closed our investigation and ruled on the manner of this woman’s death, but I think we are leaning toward (reckless) homicide.

Is driving distracted by eating or texting or doing your nails really any different than being distracted by the effects of alcohol?

Yes I know, and truly believe, that the driver’s self punishment is going to be greater than anything the court system could mete out, but that is no reason to not prosecute this case as you would any other similar case. If it is wrong, it is wrong. If you pursue it in some, you should pursue it in all. Reckless homicide is not restricted to cases in which intoxication is demonstrated.

Added: Interesting fact from an article I just came across

A study by the National Highway Traffic Safety Administration and Virginia Tech Transportation Institute showed that simple distractions - talking on a cell phone, reaching for something on the floor, looking too long at something on the side of the road - caused 80 percent of the crashes and 65 percent of the near-crashes observed.

Coroner: Killer Heroin Isn’t From Mexico

I got in a discussion (argument is just a bit too strong) with an Associated Press reporter yesterday (Hi, Sophia). It became rapidly apparent that she had already written her article and wanted only quotes and information that went along with what she had decided the story was.

She called to ask about the recent increase in heroin deaths that has occurred here in Lake County, an increase that I have attributed to (and demonstrated with testing) an increase in purity or strength of our heroin on the street. She asked the usual questions about the ages of the victims, other demographic information, and about them dying nearly instantly upon injecting. It all seemed to be going along fine as fact finding until she asked where I thought the heroin was coming from.

I told her that based on the fact that it is white heroin that it comes from Colombia or Asia (and that in turn based on Department of Justice information). She then asked about heroin from Mexico. I explained that Mexican heroin is either brown or black and not white. She pushed the Mexican source theory, “because of all the violence at the border”. I explained that while some of the Colombian heroin may come through Mexico; the stuff we are seeing is not Mexican in origin. “It has to be”, she replied. I explained that most Colombian and Asian heroin does not come through Mexico, but directly into the US in other ways. Violence or not, her preconceived notions or not, the heroin on our “streets” is not Mexican. She quickly ended the interview at that point, asking if there was anyone else she could talk to in the County, undoubtedly looking for someone to support her incorrect thoughts on the matter.

So no matter what she ultimately reports, I want you to know that white heroin (the predominant type used east of the Mississippi) is from Colombia and, in ever growing amounts, from Southwest and Southeast Asia. The black tar and brown powder stuff more used to the west is the stuff from Mexico.

File under: fun facts to know and tell.

Coroner and Parent Trying to Forestall Death Isn't Easy

A death occurred over the weekend, actually several occurred, but I am writing about just one of them.

A woman riding/driving a motorcycle died after being hit from behind by a car. I talked to reporters and gave them part of the story: the motorcyclist had stopped at a yellow light, the driver of the car was driving distracted (I would not give any details as to what that entailed) and did not stop for the yellow light, striking the motorcycle. The motorcyclist was thrown from her cycle and was pronounced dead at a local hospital shortly after the crash.

The next reporter to call, called after seeing the story on the website of the first reporter’s newspaper. He said he read in the posted article that the driver of the car was doing her nails and asked if that was indeed the case. Apparently, the first reporter got the story from law enforcement personnel involved in the investigation of the case.

Subsequent newspaper stories were not too careful with attribution of that part of the story, so many have assumed it came from me. Oh well, what can you do.

Beyond that, I really wanted to write about another aspect of the whole deal. After the call from the second reporter (he was only one of four reporters I talked to on Sunday about the death) I talked with my 18 year old daughter about the death, always trying to impress upon her to make good choices and not take chances. I mentioned that the story was up on the Internet about the distracted driver in the crash. My daughter’s response was that she sure wasn’t going to do her nails while driving again.

I wouldn’t have guessed that she would ever do such a thing, but apparently so. As a parent it is difficult to think of all the things you need to warn your children about. That is an incredibly difficult job.

Swine flu perspective

Swine flu. Be afraid, be very afraid. People are fearful and demanding that something be done. Government officials are clamoring to do something. Wait, that was from news reports in February of 1976.

The swine flu has been here before. It was here in 1918-19 and again in 1976. It is not new. It cannot be caught from pork food items. Yes, it can kill, but so does the more common flu. The post-WWI swine flu killed 500,000 in the U.S. (and recent evidence points to it having started here). The outbreak in 1976 killed one (however the hurriedly set-up vaccine program killed and debilitated hundreds). Our usual seasonal flu kills about 36,000 each year. We need to keep this swine flu in perspective. Don't panic, no matter how the media frenzy pushes you. Yes, even one death is too many, but unfortunately death happens and not all of them can be prevented.

Wash your hands and do the things you usually do to not catch the usual seasonal flu -- eat well, drink plenty of fluids, get rest -- all bolster your immune system.

Will we have a replay of "the Great Plague," as the 1918 pandemic was called? Not likely. Times have changed. Living conditions have improved. Sanitary conditions have improved. Underlying health status has improved. Healthcare has improved.

Be aware, but don't be swept away.

Coroner riffs on heroin deaths

As one of the local police chiefs told me today: “it is your fault”. I pushed out the information a little while ago that we have had an increase in our number of heroin deaths, with a significant peak last December, and demonstrated with test results that it is at least in part due to an increase in the purity of the local heroin. Apparently because of that heroin deaths are really getting noticed. Other counties have put out information that they, too, have seen increases in their numbers. Newspapers, TV and radio stations have done reports. Everyone wants something done and those that can do something want to do something (hence the police chief’s call).

We need to guard against misinformation and incorrect conjecture about who, what where, and why. In our county (and I would guess the same is true in other counties) the heroin deaths are occurring throughout the county, across geographic and socioeconomic “boundaries”. With many of them, particularly among the young victims, there seems to be a significant predilection for those with disposable income and extra free-time (just as we see in underage drinking, although I know they are very separate problems).

This is not a “gang problem”, as some would have you believe, it is easier to say it is gangs (the others) than to work to seek out the real sources and solutions. While a big local source is the “west side markets in Chicago”, our local resellers are local kids/folks in affluent and poor neighborhoods alike.

I have been asked in a couple of recent interviews (including one yesterday for a Chicago college newspaper) is it the increased purity alone or is there increased use. I believe it is both. The “new” heroin is deadlier and more addicting. It is easier to use, you can inhale it and you don’t have to inject it. One “new” group of users we are seeing are those folks who start with pain pill use that progresses to over-use and abuse. Then for several reasons they switch to heroin, it is cheaper, easier to get with no doctor or ER shopping required, also when your doctor cuts you off you have to go somewhere.

What to do? I do know that we have to use all the resources we can, all of the sources of information that we have (including the previously unused information that Coroners and MEs have). We need to increase addiction treatment availability, the entire spectrum of treatment options. We need to inform folks that this is happening and not let the public and public officials ignore the problem. This is going to require work and cooperation. Not just the Coroner, not just police and other law enforcement, but moms and kids and other just plain folks. We must get creative with solutions and with information acquisition.

What we are doing now isn’t working. People are dying, kids are dying (an 18 year old last Friday).

Coroner gets bouquet of bones for Spring

Aah, the first signs of spring. The crocuses are blooming and the daffodils are pushing up through the ground. And one of our “signs of spring”, the bones are appearing

We have had several “bone cases” through the last couple of weeks. People, and particularly dogs, find the bones as the snow goes away. Folks are concerned that they may have happened upon some grisly murder and dismemberment scene and we get called. We get called either directly by the finder or, more commonly, by the law enforcement agency that the bones are turned into.

The picture posted above actually involved a radio interview (XLC) because one of the morning show’s host’s dog found the bone. The host was convinced that it was a human bone, the victim of an ax murder. To her dismay, it is a much more mundane animal bone, not human.

I am glad to say that all of our cases have been animal bones, so far this year. It does happen that we get a human bone or skeleton from time to time, again particularly in the Spring

Cyanide death

Although we don’t encounter cyanide related deaths very often, I have written about it before.

We had a cyanide death recently in our County. Word of the woman’s death “leaked” to the media and I got a half dozen calls from various outlets. I say “leaked” because I didn’t report it to the media (I get calls daily asking for information on “reportable deaths”, i.e. deaths they can do news stories on) because in our ongoing investigation at the time we were trying to decide between suicide and accident (the local media does not do stories on suicides, unless they are public).

The woman had died by inhaling cyanide gas, there was no evidence of a caustic ingestion, after generating the gas by mixing crystalline cyanide with an acid (or possibly with water, although this is a less “efficient” chemical reaction to generate hydrogen cyanide gas than the acid).

The media questions were interesting, but settled into disappointment after talking with me. I still do not know where their limited (incorrect?) initial information came from. I got questions like: Was she murdered? Did someone inject her with the cyanide? Was she hit and then given the cyanide? Etc.

No real story here. Based on our now completed investigation it appears it was an unfortunate accident. She apparently had the cyanide in her home for over 15 to 20 years. She had gotten the opinion of a “chemist” and/or from the internet that cyanide loses it toxicity over the years and becomes non-toxic after 20 years (important note: that is not true!). She did post a warning to anyone who might be entering her home that there was cyanide in her home. We surmise that she was cleaning up the cyanide in her basement (likely in preparation to move south) when the gas was generated by chemical reaction and she was overcome and died.

More on deadly heroin

Headline 1 today: Spike in suburban heroin deaths

A story about the apparent increase in heroin related deaths across several local counties, with a law enforcement report of increased heroin seizures and arrests. It even mentions an increase in folks seeking treatment of heroin addiction in the area (great to see that).

Headline 2 today: Heroin in Fox Lake death of lethal purity, official says

(That official being me) An article about our finding (of course, with the help of DEA testing) increased purity/concentration of heroin in at least some of our cases as an explanation of Headline 1.


Increased availability of increasingly deadly heroin, what a foundation for disastrous consequences.

Law enforcement needs to cooperatively work to track and stem the flow (we will do all we can to help here), courts need to push folks to treatment, and treatment programs must gear up to treat those in need; or we will continue to see increased business from a drug originally spelled “heroine”.

Potent Heroin

We had a very concerning spike in heroin-related deaths this last December (8 in one month), which seemed to be a part of an apparent trend in such deaths. Because we found no adulterants in the specimens we obtained at the scenes of these deaths, nor in the bodies of those decedents, our thought was that there must have been a spike in the concentration of the heroin used. (As I was quoted in one article, it brought to mind the movie “American Gangster” in which a more pure heroin brought to Harlem resulted in a large number of deaths in the users.)

We felt that the concentration or purity was important information to know for our death investigations in these cases; as well it would be important information for local law enforcement agencies. We were able to get the DEA to do the testing for us.

The results have just come back. While they reinforce our opinion, they are nonetheless striking. We were able to send samples from 2 cases. (For comparison, let me mention that currently the average purity in Chicago is about 15%) In one case the purity was 23%. That is an increase of 50%. If you are used to shooting 15% stuff, a jump in purity of 50% certainly has the potential for lethality. The other specimen was even more impressive. It had a purity of 65%. That would be high-grade for snorting, if you shoot it you die with your syringe under your body.

I certainly do not advocate heroin use and support increased availability of treatment for addiction, but I also think it is crucial that we get this sort of information out so that users can know. When you get this stuff “on the streets” you never know the quality of the stuff. It could have lethal adulterants. It could be a lethal concentration. Maybe knowing that will deter some from using.


A couple of other points: I would note that we are working on developing the capability to do future purity testing in our lab; we are the only Coroner’s office in Illinois with our own toxicology lab. Once that is established we will be able to follow this trend continuously and help local law enforcement agencies with fast turn around in these results for their investigations.

The other piece we are working on is to better “quantify” the observation that these heroin deaths are not confined to our poorer neighborhoods, but span the county and its varied socioeconomic climes. That tells us that this is not a “disease” of the poor and that it is not a “gang problem”, both of which are ingrained opinions that need to be dispelled if we are to realistically address and remedy this problem of heroin use and heroin-related deaths.

Youth against drug use

This from a new facebook group that a friend sent me the link to:

This is our chance to create a movement for the fight in the war on drugs. Our youth are dying from the lack of awareness to our community's drug prevalence. Our suburban community officials don't believe it's a problem! "Not here, not in this town." Let's raise awareness! Don't let the people we have loved and lost be forgotten. They were all beautiful and irreplaceable human beings. Let's continue to honor their memory and raise awareness-- we can't let this continue to happen. We need to be their voice. It "is" happening in our towns! Open the eyes to those who are naive. Otherwise we will continue to lose those that we love. Together we can make a difference.

Interesting (and honest) stuff, spread the word.

Pain Killer Misuse can be a Killer

Treatment admissions for prescription pain killer misuse has risen dramatically over the past decade – from constituting 1 percent of all admissions in 1997 to now representing 5 percent, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA).

That reflects what we are seeing too, increasing numbers of deaths from misuse of prescription pain meds. The numbers aren’t huge but they are there, another one today.

Drugs they can thrill ya, they can kill ya.

Ain’t no caring in much of our healthcare

WTF—I guess that is a bit strong, but it communicates my feelings after a call I got last night from a friend of mine. What is with healthcare providers?

I know this guy (granted most stories that start out that way don’t go well, but this isn’t that kind of story) who crashed his dirt bike (or was it an ATV?) and broke his leg a few weeks ago. Young guy in his 20s, healthy, unemployed and with no health insurance…

He had done work on his vehicle in preparation to sell it. He took it out for one last ride to make sure all was well for the sale, but crashed instead, an accident. The crash resulted in multiple fractures to one of his legs. He went to the local ER, got splinted and told that once the swelling improved and they were certain it wasn’t infected at the time of the trauma they would do a surgical repair.

Back to the hospital he went 2 days ago, they loaned him a wheelchair, called a medi-van, and took him to the local orthopedist’s office. The orthopedist said that, indeed, he needed surgery for repair of the injury (and for the best outcome) and as soon as he came up with $30,000 cash he would be more than happy to do the surgery. The guy I know doesn’t have that much, so out of the office he went (with the wheelchair).

A friend of his suggested that he go to another hospital, surely they would see that he get the needed care. A young guy ought to have the treatment he needs so his leg can be the best it can be after it heals. He may need his leg to work, if a job becomes available. He might not want to spend the rest of his life in chronic pain nor with impaired mobility from suboptimal care and healing.

He went to another hospital, one his friend thought would surely help. He presented in the ER, because he had no other access to care. He was told (I am sure in a very caring way, they are a caring medical center, so much more than just a hospital) that if he paid 100% up-front they would be more than happy to give him the care he so obviously needed. There was nothing they could work out, there were no options, there wasn’t any real access to care. WTF.

Rambling thought

I just got an email with a widget I could attach to my blog from Wellsphere (my blog is cross posted there). The widget contained a definition of “perseverance” that I don’t agree with:

The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack of will.

I disagree with the last word.

“Persistence despite obstacles” would work for me, but saying they lack “will” is wrong. There is a need for an action in the definition. Success is action, perseverance is action. The definition should communicate the need for action. Many have the will to accomplish something, but do not take action. (On the other hand, some times the obstacles win no matter your action.) But nothing fails faster than a lack of trying.

Heart attacks don’t only attack ‘old folks’

Shocked, concerned, dismayed, I’m not sure what word to use.

In the last couple of weeks we have had 3 folks in their 30s die due to heart disease. Granted they were overweight and had histories of hypertension, but seeming so young to have life-threatening (life ending) heart disease. Most of the time you don’t think of heart disease killing at such a young age.

What is going on? These folks, for the most part, didn’t access our healthcare system for personal of financial reasons (that can be hard to sort out, not being able to talk with the person involved in the decision making). Apparently, they weren’t able, for whatever reason, to make life style changes to impact the obvious risk factor with diet and exercise. Folks need to know the health decisions you make at any age (even when you are young) can, and does, impact your longevity.

Do what you can to not die before your time. Make good choices.

Coroner's office and child safety seats?

Press release we sent out today:

For Immediate Release

The Lake County Coroner’s Office is proud to announce its new partnership with Safe Kids Chicago, a Division of Children’s Memorial Hospital. The Safe Kids Buckle Up program strives to offer every driver who transports children, the opportunity to learn how to properly restrain children in age and weight appropriate car and booster seats. The office now has two deputies that are certified child passenger safety technicians.

“While 94 percent of America’s children are now regularly restrained, not enough kids are properly and safely restrained. This puts children at an unnecessary risk of being injured or killed in crashes because they are simply in the wrong car or booster seat or it is not properly installed” said Dr. Richard L. Keller, Lake County Coroner.

Parents are encouraged to make an appointment to bring their car or booster seats for inspection. The certified deputies will help parents learn to adjust the harness and properly place the car or booster seat in the vehicle.

To make an appointment for inspection, please call the Lake County Coroner’s office at (847) 377-2200.

Spike in heroin deaths

This certainly caught the attention of the local media. Headline:

Heroin deaths on the rise
County officials blame change in percentage of purity

I was called by a local reporter about a drug-induced homicide case going to trial and I mentioned an apparent increase in heroin deaths recently (2008 to now) and my suspicion that it might be related to an increase in purity of our street heroin. An increase in concentration was inferred by our increase death incidence, our testing finding no adulterants similar to some cases of Fentanyl-heroin we saw in the past, and that some of the cases seemed to look like “hot-shot deaths” (syringe barely out of the arm). So we sent several samples found at death scenes to the DEA for purity/concentration testing. Many areas of the country monitor their concentrations (for example, Chicago found a 14.6% to 21.4% jump in 2007), our county has not followed that measure in the past but I think it is important information to have. We await our testing results.

Also, hopefully getting out this information to the public can help drive down heroin use and encourage folks to seek treatment for their addiction (and decrease deaths).

Beat the Reaper

Cool way to get the word out (as I have said before teens must get learning messages in multiple ways multiple times for it to sink in):

new interactive computer CD intended to help young people anticipate the disastrous consequences of choices they're often confronted with…

…Beat the Reaper…

I haven’t seen the CD yet, but I welcome anything that helps teach kids to think, to not take chances, make good choices, and live.

Four prescription painkillers and a half bottle of wine were all it took.
Stephen Pheasant, 15, of Benton City, ingested the concoction one night early last year, and he never woke up. His death was a shock to his friends and family, but most of all, it was an outcome he didn't see coming…

His story is one of several real-life examples included in a new interactive computer CD intended to help young people anticipate the disastrous consequences of choices they're often confronted with.

Non-medical use of pain relievers

From a SAMHSA press release:

Adults aged 18 to 25 currently using pain relievers for non-medical reasons increased from 4.1 percent in 2002 to 4.6 percent in 2007…

youths aged 12 to 17 … non-medical use of pain relievers … declined from 3.2 percent in 2002 to 2.7 percent in 2007…

Use among adults aged 26 or older increased from 1.3 percent to 1.6 percent

While the use among 12 to 17 year olds seems to hold some promise, it remains a topic rarely spoken of or adequately addressed in in-school programs, as far as I know. Over-use and abuse of prescription pain relievers is a large problem for society (“5.2 million people aged 12 years or older in 2007”), yet it remains poorly addressed. It is multifaceted in cause (not just to get high), contributing factors (diversion, over-prescribing, poor control/understanding of effects, etc), and the way it is viewed (‘not as bad as using street drugs’).

My other thought on this: how many of these folks will move on to illicit drugs? I have not seen that sort of research and it might be a bit tough to do. But, in my limited experience, a fair number of them will. In many places (like our county and its surrounds) heroin is cheaper and easier to get than prescription pain relievers on the illicit market, making it a fairly ‘natural’ switch. Using illicit drugs and/or the illicit marketplace often contributes to social, legal and societal problems compounding the “effects” of the drugs.

Medical Homicide

I was reading an article on “Medical Homicide and Extreme Negligence” in my recent edition of The American Journal of Forensic Medicine and Pathology (no link). Having had a case of medical neglect found to be homicide by an inquest jury it was nice to review some of the pertinent definitions. We will continue to watch for other medical cases along with our “more usual” investigations:

Reckless endangerment…the conscious disregard of a known substantial likelihood of injury to the patient

Criminal neglect typically is defined as the failure to provide timely, safe, adequate, and appropriate services, treatment, and/or care to a patient.

In instances of extreme medical negligence, a homicide manner of death is appropriate because the fatality is due to criminal acts (or inactions) of another.

I stand by the jury verdict in our case and will not hesitate to rule similarly in the future if I feel that the case meets these definitions.

Natural deaths…natural disease... Therapeutic complications…predictable complications…appropriate medical therapy…Accidents…unanticipated complications and/or inappropriate therapies…Homicides…death at the hand of another person or death due to the hostile or illegal act or inaction of another person.

Our ruling of a homicide does not mean criminal prosecution should or will occur, but, importantly such a ruling:

…also furthers one of the major goals of the medicolegal death investigation system, which is to safeguard the public health.

(American Journal of Forensic Medicine and Pathology, March 2009; 30: 18-22)

Our healthcare crisis is Coroner job security

This does not bode well for health and longevity:

At the onset of bad economic times, the demand for psychiatric services declines, with fewer visits for "maintenance" but eventually more for acute episodes…

I expect that medical care providers will first see a small decrease in demand as copayments become more onerous, more patients lose their insurance…

As time passes, however, I would expect to see increased demand for services from people who "deferred maintenance" because of costs and therefore become ill.

Along with this:

As economic conditions continue to worsen, the public is increasingly worried about the affordability and availability of care, with many postponing or skipping treatments due to cost in the past year and a notable minority forced into serious financial straits due to medical bills, according to the Kaiser Family Foundation’s first health care tracking poll of 2009.

All great for coroner job security, but a crushing problem for people and our country.

The time to do something about “healthcare reform” is now (realizing that when most folks talk about healthcare reform they are talking primarily about reform of how we access and pay for healthcare). Everyone must have access to care (and not just acute care), we must make prevention and wellness a high priority, we must make sure health care is safe and of high quality, and health care coverage must be affordable and portable.

"Second Opinion" on Suicide Cases

This is interesting. It may serve a real need.

Nancy Ruhe, executive director of the National Organization of Parents of Murdered Children…says that in cases in which a death is labeled a suicide but the family believes otherwise, her group offers what it calls a Second Opinion Service.

SOS will hire independent forensic pathologists, firearms experts and legal experts to investigate even further, Ruhe said…

Even when the research turns up nothing new and experts still label it a suicide, it still helps families, because they can know why, Ruhe added.

"Most police departments and medical examiners' offices, they don't explain that," she said. "They just rule it suicide. So you have all these unanswered questions."

Every one of our cases undergoes thorough investigation before cause and manner of death is assigned (for “inquest cases” this occurs after a full-staff case conference, now since the law changed). We do answer any questions family comes to us with, so while there are often many questions after a case is ruled suicide we can back that decision up with investigative evidence.

Suicide is often difficult to accept in a loved one, but it happens more often that most folks think.

Some forensic science is not science

Just as folks are making more and more demands on us and all of the criminal justice system based on what they see on TV, this report comes out:

The National Academy of Sciences says many courtroom claims about fingerprints, bite marks and other evidence lack scientific verification. It finds forensics inconsistent and in disarray nationwide.

The report from the Academy makes several recommendations for improvement in our current system to ensure scientific validity in testing and what passes as evidence, as well as “certification” of expert witnesses. All of that would be a great step forward, but I think we need to include one more thing. We need to tell the public that all those TV shows are not real.

Those high-tech gadgets often don’t exist. Fingerprints are often not easy to get and they are not 100% accurate. Not everyone’s prints are on record for identification. You can only infrequently get a print off the trigger of a gun and then it is only partial (a sliver) and useless, for the most part, in telling you who pulled the trigger (questions we have gotten in the past). Testing for the force needed to inject someone with a syringe tells you nothing about “who did it” (based on a recent question to our office, which in turn was based on something they saw on TV).

At least some of the inaccurate testimony and “bad science” that makes it into investigations and courtrooms is driven by the public’s expectations, driven by TV. Get a grip folks its entertainment not reality.

New Medical Resource

I ran across something interesting today: Medpedia

Medpedia’s mission is to create a new model for how the world will assemble, maintain, critique and access medical knowledge. This repository of up-to-date, unbiased medical information will be freely available to everyone...

It is new and a work in progress. Don’t expect it to have everything you are looking for now, but someday…

Their goal is to be collaborative, yet at least somewhat authoritative. They are doing that by partnering with a few medical schools/institutions to fact-check posted material. I think it sounds like a great concept and I wish them luck. I haven’t gone through many of their articles, but will likely refer folks to it when they are looking for medical answers or is that answers to medical questions.

Pop Kills

More evidence high fructose corn syrup ain’t good for you:

Another study has demonstrated that consuming beverages that contain high fructose corn syrup contributes to spikes in serum triglycerides, really nasty fat transporters that clog your arteries and can help make you die.

"Increased triglycerides after a meal are known predictors of cardiovascular disease," explained lead author Karen Teff, PhD. "Our findings show that fructose-sweetened beverages raise triglyceride levels in obese people, who already are at risk for metabolic disorders such as cardiovascular disease and diabetes."

Yes, pop (soda for you not of the Midwest) kills (or at least pop sweetened with high fructose corn syrup, glucose sweetened not so bad)

Parents Have More Power Than They Think

From a newsletter put out by LEAD (Linking Efforts Against Drugs) a parent group fighting drug use and underage drinking in the local communities of Lake Forest and Lake Bluff.

Parents Have More Power Than They Think!

Many parents have told us that they think they don't have much power to influence teen behavior, especially regarding underage drinking. There is some information you might want to know....you have more power than you think!

1. The recent survey among local teens indicates that those whose parents had firm rules about drinking and drug use were 50% less likely to engage in this behavior. Setting boundaries and clearly communicating them does make a difference!

2. National youth surveys also indentified that the #1 reason teens don't drink is that they don't want to disappoint their parents. It helps to make it clear that you will be disappointed in them if they drink or smoke marijuana.

3) Driving is one of a teen's most precious privileges. Did you know that you can revoke that priviledge for drivers under age 18? If you have concerns about your teen's ability to handle the responsibility of driving, or you need to make a strong statement about consequences of some poor decision making, contact the Secretary of State's office more details. You can also view your child's driving record (is there a ticket you don't know about?) on line up until they are 18 years of age. Go to www.cyberdriveillinois.com for more information.

a blast from the past

My most comment attracting post: Cocaine and Death


I promise more new ones are on the way.

All death is sudden

We are all unprepared for death, our own and the deaths of others in our lives. We see it in families whose children die, whether 16 months or 29 years. We see it families who lose their elders, whether 54, 68, or 90. All deaths are sudden. We even see it in families of folks in hospice care.

It is the hardest “rite of passage” of them all. I have written before about programs that teach folks (like gang-bangers) to value life by having them witness birth, but there is nothing like experiencing a death of a loved one to drive home the value of life.

They aren’t there to do all the things they used to do, the stuff you loved and the stuff you hated. Your relationship to the world changes because that “pillar” is no longer there. You want to know why, why did they die and why did they live. You want to know what comes next, for yourself and for the one who has died.

We try to prepare ourselves for our experiences with death. We tell ourselves that all things die and anyone can die at any moment. Life is only a temporary state of being. But how do we truly prepare? Think about it; work through it in your brain and in your mind and in your soul.

Nonetheless, all death is sudden.

Concussion = Brain Damage (and death)

Until recently we (the medical community) thought that concussions were pretty innocuous. Sure the blow to the head might cause brief loss of consciousness or change in mental state (stunned, confused, etc) but it was believed that it caused no residual brain damage.

All that is changing: cumulatively concussion can and does lead to “chronic traumatic encephalopathy”. While it was first described in professional athletes who have taken repeated severe “shots” to the head, recent studies have found it in kids as young as 18 years old.

The long-term symptoms of this disease are mood changes, anger management problems, Alzheimer’s-like symptoms, and death.

Certainly more study is needed, but in the interim we need to be aware that this can start in teens. We need to take “simple” concussions very seriously, and maybe we shouldn’t expose the adolescent brain to forces and activities that can damage it.

Make good choices, don't take chances

Interesting regional drug information

Tidbits from the National Drug Intelligence Center (Dept. of Justice):

Cocaine trafficking and abuse in our region is widespread, however a rather sudden decrease in purity in the 2nd half of 2007 may be indicative of decreasing supplies.

Heroin abuse in the region is increasing, particularly among young white adults and teens. Many of these new and younger abusers have transitioned from prescription opiates.

Heroin availability has increased and is reflected in increased purity levels on the streets and lower wholesale prices. As a matter of fact, the DEA is quoted as having found the first increase in “retail-level” heroin purity in Chicago in 10 years (from 14.7 % to 21.4%). The purity had actually had been steadily declining over that 10 years.

That information, along with data about other drugs, certainly makes it plain that we need to increase our efforts in prevention and treatment (actually secondary prevention), particularly in regard to heroin and other opiates. Many of the current prevention efforts are not going to cut it. We need to start pretty early with age and culture appropriate, factual, repeated education. The message must be clear, consistent, repeated in various ways and through various outlets. Not to scare, but reality based. Drugs (particularly cocaine and opiates) kill. Yes say no to drugs, but you need to know how and why.

Unconventional Coroner?

Photo used in the article

Yes, I am unconventional (from an article in the Lake County Journals):

With a stud in his left ear, a dragon tattoo on his forearm and a blog he updates regularly, Dr. Richard Keller is probably not your average county coroner. But Lake County voters must like what they see...

Healthcare reform to forestall death and treat economic dis-ease

I was talking with a reporter yesterday and he brought up that I have posted a few times about the lethal effects of the lack of healthcare coverage in our county/country. He asked if I thought people were as aware of that crisis as they ought to be. I don’t think that they are, but as this economic crisis feeds the access to healthcare crisis it is being brought home for more and more people, unfortunately. While my feelings on this matter were first painted by my experiences in ER Medicine, at HealthReach (a free medical clinic I founded and served as Medical Director and Executive Director) , and the Lake County Health Dept., my experiences as Coroner have reinforced my feeling that lack of healthcare access is lethal. So I thought I’d throw out some related facts and comments I ran across lately (not sure just where).

Health care reform is an essential part of restoring America’s overall economy and the finances of working families.
15.3% of Americans lack health insurance
23% forgo necessary care every year due to cost
22,000 uninsured adults die prematurely each year as a direct result of lacking access to care
Health insurance premiums have increased 117% for families and individuals in the last decade
Health insurance premiums have increased 119% for employers in the last decade

I have been surprised that the automakers haven’t screamed for healthcare reform because

$1525 of the price of every GM auto is due to healthcare costs

New American Foundation:

We must reform our struggling health care system not in spite of our economic crisis, but rather because of the impact healthcare has on the American economy

Healthcare reform has to happen now, not only because it is a social justice issue, but because it is a central economic issue as well. It really can go a long way toward forestalling death and help personal and societal financial dis-ease.

Change healthcare and impact death

Again I read an interesting article.

What a great reinforcement for the notion that prevention or early detection should be the focus of funding and energy in Medicine/Healthcare. Yes we need to treat illness, but the “most bang for the buck”; the greatest impact on community/people’s health (and deaths) is with prevention and/or early detection with access to definitive care at that point, not when care becomes more costly and the chance of cure minimal.

The survival rate for many cancers is similar to the cliff-like curve that defines ovarian malignancies. Find the disease early, thanks to a stray blob on an x-ray or an early symptom, and the odds of survival approach 90 percent. Treatment—surgery—is typically low risk. But find it late, after the tumor has metastasized, and treatment requires infusions of toxic chemicals and blasts of brutal radiation. And here the prognosis is as miserable as the experience.

The Canary Foundation has that as its mission (not an endorsement, but applause):

Canary Foundation is a non-profit dedicated to the goal of identifying cancer early through a simple blood test and then isolating it with imaging. Our collaborative research programs span multiple disciplines and institutions.

We need to examine our healthcare system and quit dumping money only into glamorous (?) high-tech, late interventions for cancer (and other “disease states”). That is not the way to do it. Healthcare reform must be about access, ensuring quality, and cost containment not just focusing on funding or payor. Certainly cost containment must rely heavily on prevention and early detection and intervention. Don’t constrict your view of “healthcare reform”. Impact death, impact health; change our payor system, but primarily allow for access, ensure quality and contain cost for the whole system to work, to change.

We do our best to prevent deaths

Excerpts from written comments of students that attended health classes spoken to by my staff:

I also learned that people make lots of stupid decisions near me. That part scared me a bit, the fact that people who could be driving on the same street as me could make a bad decision that could kill me, even if I am being responsible.

At school we have presentations all the time on drugs and alcohol and telling us not to do them. But I think your presentation was the most effective, because you actually got to see what they did to your body.

I believe this is mostly a mental battle that has to be overcome by a person’s common sense rather that their desire to be with the crowd. … I feel if a person can just build the mental capacity to avoid, their bodies will develop and grow more quickly and strongly than those of the ones who give in. Especially when driving, if their mental abilities are lacking or being focused on some unimportant social factor, they can cause serious harm to themselves and others.

Now I truly know the risks that I am taking no only for myself but for others if I put harmful substances into my body.

Your presentation was inspiring as it made me realize how fragile life is. It made me aware of just how important it is to make the right choices. You pointed out how being at the wrong place at the wrong time could be deadly. I found the facts you shared both interesting and at the same time frightening.

Sharing information, teachable moments, repeated presentations of truthful information, that is how you teach kids, that is how they learn

July 4, not Jan. 1, top crash death day

I was sent a link to the snopes website the other day that referenced the question of whether Jan. 1 (or the Dec. 31 – Jan. 1 combo) was the deadliest night for traffic crash deaths as is often believed. As I was already aware, it is not. So I thought I’d share that little tidbit. Jan. 1 is actually number five on the list of deadliest days for crashes. It is topped by July 4, July 3, Dec. 23, and Aug. 3 (in that order). Also of interest is that it virtually ties 3 other days in August.

While alcohol is a big factor in the crashes July 4 and Jan. 1, with 41% and 51% intoxicated drivers, respectively, one of the biggest factors in the rankings is that folks drive more in the summer. More cars and more driving mean more deaths from car crashes (it’s a numbers thing).

It is important to not drink and drive and not to ride with someone who has been drinking and is driving. But also keep in mind that these deaths occur no matter the weather, no matter the time of year (although remember the spike of crash death in the summer); you never know when this could happen (it may be the other driver), so do your best to always drive prepared as well.