Tuesday, January 27, 2009

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.

Monday, January 26, 2009

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...

Tuesday, January 20, 2009

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.

Wednesday, January 14, 2009

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.

Tuesday, January 13, 2009

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

Monday, January 05, 2009

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.

Friday, January 02, 2009

Drugs can kill you even when "sober"

I read an interesting study/article the other day (it was recently sent as a pdf, so no link). Sure it doesn’t have the general appeal of the movie “Bedtime Stories” that I went to yesterday, but it brings up an interesting point for the Coroner Biz.

The conclusion of the study was that:
“Decedents with a history of chronic drug abuse appear to be at an increased risk of dying by their chronic drug abuse, even in the absence of any anatomical or toxicological finding at autopsy…” [Arch Pathol Lab Med, vol 132, Dec 2008, 1903-1906]

This really is contrary to what has been commonly thought; that drugs really only kill when they are at elevated levels in the body and sober deaths are not really related to the drugs.

Their original hypothesis was that “drug abuse induces some change that persists after the drug is no longer detectable in the body…presumably at the molecular level…increase(s) the likelihood of sudden death”. (This molecular level of effect brings to mind William Burroughs’ saying in “Junkie” that the junk gets into your cells with use, causing addiction, and has an effect basically forever.)

The study did find this effect in a broad range of drugs of abuse, some that you would suspect, but also others that might seem a bit of a surprise. The drugs included cocaine, amphetamines, opiates, other pain meds, benzodiazepines, and barbiturates.

The authors relate this increased risk of sudden death with chronic drug abuse to the already recognized similar occurrence with chronic alcohol abuse.

So, yet another reason to not abuse drugs: an increased risk of suddenly dying, even if not acutely intoxicated at the time of death. That should give folks pause and new meaning to a phrase I have used a time or two: “Drugs, they can make you high, they can make you die”.