"Live from the Coroner's Office"

Grad School

2010-05-16T17:32:00.002-05:00

I haven't posted in quite a while and I am not sure if anyone even bothers to look here any more.I thought I did owe folks an explanation, in case they drop by again.

The primary reason I am not posting is that I am in online Grad School working on a Masters in Secondary Education. That is consuming all my free time. Two papers a week and participation in online discussions takes time and my creative juices. I am preparing for life after the Coroner's Office (December 2012). I have decided on a career change to what has always been my second choice for a career. I am going to teach high school or middle school, and I am looking forward to the future.

As I told a group of students recently at a career day event I participated in. Never be locked into what you think you are going to do for the rest of life. We really can never be sure what we will "do" "when we grow up".

“Relief-oriented use of marijuana by teens”

2010-01-04T13:35:00.001-06:00

That is the title of an article in last April’s Substance Abuse Treatment, Prevention and Policy.

While this study in has a very small sample size, it nonetheless presents an interesting point, and one that needs to be taken into account when attempting to limit the use of illicit drugs (and the illicit use of licit drugs) by teens.

…these teens differentiated themselves from recreational users and positioned their use of marijuana for relief by emphasizing their inability to find other ways to deal with their health problems, the sophisticated ways in which they titrated their intake, and the benefits that they experienced…Marijuana is perceived by some teens to be the only available alternative for teens experiencing difficult health problems when medical treatments have failed or when they lack access to appropriate health care.

One of the common reasons for use of illicit drugs is self-medication. Certainly a completely different approach would be needed in these individuals than in recreational users. Likely these folks present a different set of challenges.

Driven to Distraction

2009-12-17T11:40:00.002-06:00

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

2009-12-16T11:15:00.002-06:00

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

2009-12-03T10:39:00.002-06:00

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

2009-11-23T10:54:00.001-06:00

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

2009-11-12T11:00:00.002-06:00

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?

2009-11-02T16:59:00.002-06:00

Photo Post: Swine flu fears

2009-10-28T13:16:00.001-05:00

Writing and Arithmetic

2009-10-28T13:14:00.000-05:00

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

2009-10-15T14:49:00.001-05:00

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

2009-10-07T09:53:00.000-05:00

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?

2009-10-06T16:49:00.002-05:00

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

2009-10-02T10:10:00.001-05:00

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

2009-09-30T17:07:00.002-05:00

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

Bullet shortage

2009-09-29T10:44:00.001-05:00

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

2009-09-24T16:39:00.002-05:00

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

2009-09-11T15:18:00.002-05:00

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

2009-09-09T11:34:00.002-05:00

(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

2009-09-09T10:39:00.000-05:00

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

2009-09-03T10:50:00.002-05:00

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

2009-09-02T16:45:00.002-05:00

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

2009-08-10T11:40:00.002-05:00

Lake County 2007-2008 Drug Fatalities Map

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

Mapping Coroner Data

2009-07-30T15:26:00.001-05:00

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.

2009-07-23T17:04:00.003-05:00

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

2009-07-21T16:31:00.000-05:00

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)

2009-07-17T13:08:00.001-05:00

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

2009-06-29T13:51:00.001-05:00

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

2009-06-26T17:10:00.000-05:00

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

2009-06-24T15:25:00.002-05:00

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"

2009-06-24T13:33:00.003-05:00

…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

2009-06-18T16:19:00.001-05:00

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

2009-06-11T14:06:00.001-05:00

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

2009-06-11T13:37:00.002-05:00

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

2009-06-09T15:48:00.002-05:00

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

2009-06-05T16:40:00.000-05:00

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

2009-05-21T13:42:00.001-05:00

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

2009-05-12T13:58:00.000-05:00

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?

2009-05-06T11:57:00.003-05:00

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

2009-05-05T12:18:00.000-05:00

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

2009-05-04T13:42:00.001-05:00

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

2009-05-01T13:52:00.000-05:00

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

2009-04-22T16:46:00.000-05:00

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

2009-04-14T15:38:00.000-05:00

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

2009-04-07T15:24:00.001-05:00

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

2009-04-02T15:57:00.002-05:00

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

2009-03-31T15:37:00.001-05:00

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

2009-03-24T14:49:00.002-05:00

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

2009-03-20T15:00:00.001-05:00

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

2009-03-20T14:54:00.000-05:00

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

2009-03-19T11:55:00.000-05:00

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’

2009-03-18T16:04:00.000-05:00

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?

2009-03-13T16:43:00.001-05:00

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

2009-03-12T16:21:00.003-05:00

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

2009-03-10T11:43:00.002-05:00

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

2009-03-09T13:32:00.002-05:00

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

2009-03-05T16:11:00.001-06:00

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

2009-02-27T16:44:00.002-06:00

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

2009-02-20T15:23:00.003-06:00

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

2009-02-19T11:50:00.001-06:00

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

2009-02-18T11:56:00.001-06:00

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

2009-02-16T16:40:00.001-06:00

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

2009-02-16T13:31:00.002-06:00

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

2009-02-11T13:50:00.001-06:00

My most comment attracting post: Cocaine and Death

I promise more new ones are on the way.

All death is sudden

2009-02-03T16:37:00.000-06:00

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)

2009-01-27T17:02:00.001-06:00

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

2009-01-27T15:30:00.001-06:00

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?

2009-01-26T13:23:00.003-06:00

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

2009-01-20T17:05:00.002-06:00

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

2009-01-14T16:16:00.003-06:00

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

2009-01-13T14:30:00.000-06:00

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

2009-01-05T16:16:00.000-06:00

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.

Drugs can kill you even when "sober"

2009-01-02T16:37:00.001-06:00

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”.

Unusual death from reader comment (question)

2008-12-30T13:27:00.001-06:00

(sorry for the caps, that's how it came to me)

DR KELLER. I HAVE BEEN READING YOUR INFORMATION REGARDING COCAINE AND OVERDOSE. I TOO HAVE A QUESTION..ANY HELP WOULD BE SINCERLY APPRECIATED...
25 YEAR OLD MALE GOT INTO A FIGHT..
RECIEVED A STAB WOUND TO CHEST.
WOUND WAS 1.8 -BY 0.5 IN WOUND.
PENETRATES THE PERICARDIUM AND THEN THE HEART, NEAR APEX INTO THE RIGHT VENTRICLE. WOUND OF HEART IS 1.3 CENT ACROSS. WOUND DOES COMMUNICATE WITH THE VENTRICLE CHAMBER. ASSOCIATED WITH WOUND WAS A 300 MILLITER HEMOPERICARDIUM.

ONE LUNG IS 420 AND THE OTHER IS 380.GRAMS
HEART 350 GRAMS.
STOMACH CONTAINED 800 MILLI OF FOOD AND NOTED WAS A MALTED BEVERAGE ODOR.

TOX REPORTS STATES
PERIPHERAL BLOOD ETHYL ALCOHOL 0.068 G/100ML
BENZODIAZEPINES POSTIVE
CANNABINOIDS POSTIVE
COCAINE/METABOLITES POSTIIVE
TRICYCLIC ANTIDEPRESSANT POSTIVE
CARISOPRODOL POSTIVE
OPIATES POSTIVE

MARIHUANA [THC] 0.004 MG/L
MARIHUANA METABOLITE [THC-COOH] 0.005 MG/L
COCAINE 0.059MG/L
COCAINE METABOLITE [BENZOYLECGONINE 0.958MG/L
MEPROBAMATE 0.869MG/L
HYDROCODONE 0.035MG/L
HGB ALC 5.6%

AFTER HE WAS INJURIED HE WENT BACK INTO THE HOUSE AND DID MORE COCAINE.. THEN CALLED FOR 911. HE WAS ON THE 911 TAPE SNORING AND THEN PASSED OUT. YOU CAN HEAR WHAT SEEMS LIKE BUBBLING SOUNDS IN THE BREATHING.THE AUTPOSY REPORT SHOWED GASTRIC CONTENTS IN THE BRONCOHOLS. HE WAS REPORTED SHALLOW BREATHING AND PULSE RATE OF 46. ON THE WAY TO THE HOSPITAL HE DIED. WHAT IS THE POSSIBILTY THAT HE SUFFOCATED ON THE GASTRIC CONTENTS OR OVERDOSED ON THE DRUGS?? THE 300 MIL BLOOD IN THE PERICARDIUM SAC BEING DELAYED [ CONTINUING AFTER DEATH]
TIME SPAN WOULD HAVE BEEN APPOX 10MIN AFTER EMS ARRIVED BP DROPPED.
ARRIVED AT HOSP 15 MIN LATER UNDER TOTAL CPR. TOTAL TIME APPOX 28-30 MIN.
MY QUESTION IS COCAINE / DRUG OVERDOSE CONSISTANT WITH THE GASTRIC ASPIRATION. AND WOULD THE DEATH HAVE OCCURED BY THIS BEFORE THE INJURY CREATED THE 300 MILL.
BLOOD IN THE SAC??
THEY DID ALSO ADMISTER EPINEPHRINE 3X AND ATROPINE 3X .

PLEASE HELP SHINE SOME LIGHT. THANK YOU

My reply:

It would seem most likely that he died of the stab wound. The wound into the ventricle will send blood into the pericardial sac. As the pericardium fills, blood return to the heart stops with tamponade and continued filling stops. In addition, as the heart stops beating no more blood flows into the pericardium, because of the loss of pressure in the ventricle.

The aspiration of stomach contents may have occurred just before death, but is just as likely with resuscitative efforts in this case.

Certainly the cocaine didn’t help him, but was likely more a confounder in this case than anything. Cocaine (with his Soma and hydocodone) may have contributed some, but vomiting due to them at these levels would be somewhat unusual.

Brown Bag Review to save your health and life

2008-12-24T11:35:00.001-06:00

A Tribune article this morning talks about a recently released study reiterating the point that drug-drug interactions are very common and can cause serious problems, particularly in “older” folks.

Overall, 1 in 25 older adults risked serious drug interactions, the study found. For men ages 75 to 85, it was as high as 1 in 10.

It also points out the dangers of over-the-counter meds in these situations. Quite often folks really don’t consider over-the-counter meds as medications, even when asked by their healthcare provider.

"The public has an awareness that two prescription medications used together might be dangerous," … "But what people don't fully appreciate is that non-prescription drugs can interact with prescription drugs and even other non-prescription drugs."

Always talk with your healthcare provider about possible drug-drug interactions when they start you on a new medication or before you start an over-the-counter medication or herbal supplement. Also, you should request an annual “brown bag review” (I wrote an article for EM Reports about that recommendation years ago). In a “brown bag review” you bring in all the medications you are taking, including over-the-counter and “herbs”, and you do a sit down face-to-face review of them with your healthcare provider.

Stay safe and stay alive.

Increased THC Content in Today’s Marijuana

2008-12-23T15:55:00.002-06:00

In the name of arming parents and others with factual information, I thought I’d pass this along:

The potency of marijuana, measured by the presence of its (psycho)active ingredient, THC, has tripled since 1987, according to the latest figures from the Department of Justice's National Drug Intelligence Center

The new data from the University of Mississippi Potency Monitoring Project … was released in the 2009 National Drug Threat Assessment. [which brings to mind a question; Who knew there was a potency monitoring project?]

The new pot is certainly [more potent], but it's nowhere near as strong as some war-on-drug advocates have contended. The old White House drug czar, John Walters, has said publicly that marijuana's THC content has "increased as much as 30 times," which researchers say is not supported by the available evidence.

So in addition to pointing out the study finding that the most potent marijuana found by the folks at Ole Miss was 37% THC; the article makes two last points. First, as a point of reference, in the Netherlands their medicinal marijuana, meeting government standards, has a minimum potency of 15% THC. Second, most pot smokers control their consumption based on potency like alcohol drinkers vary volumes of consumed beer and other spirits based on their “potency”.

Nonetheless, the facts are that marijuana is getting to be more potent, its intoxicating effects will be more pronounced than those experienced by consumers in the past, and it is illegal, other than medicinal use in something like 13 states here in the US.

Don’t try and scare folks with false claims, like John Walters tried, use facts and remember: “this isn’t your father’s marijuana anymore”.

A Cavy for Xmas Dinner

2008-12-23T15:04:00.003-06:00

This hit the papers a few days ago, so I thought it might make a cute pre-holiday (except for those of you in the midst of your holiday) post:

Are hard times threatening your Christmas dinner? Well then, Peru has the answer: guinea pig.
Officials … hailed the Andean rodent as a low-cost, low-fat alternative to a traditional turkey Christmas dinner.

(And I found a photo of one that could make a meal)

Guinea pigs are a fairly common food item in Peru. They do sound healthier to eat than some stuff we eat (low fat) and less expensive than say a standing rib roast. So does that make them about the 5th “other white meat”? How do I tell the kids that it isn’t chicken?

Healthcare cost-sharing contributes to morbidity and death

2008-12-19T14:34:00.004-06:00

I came across an article published in The American Prospect Online via AlterNet. The article is entitled “Lessons from the ER” and it relates the author’s thoughts about his wife’s recent healthcare system experience. I wanted to highlight one part of the article that is certainly not the only point of the article, but it caught my eye because it relates to a recent discussion I had. I recommend you read the whole article.

First to throw out a teaser for the article as a whole:

Several people made mistakes in Veronica’s care. The worst and most deadly mistake was ours: going to this urgent-care center.

Do read the whole article (link above).

To the point I wanted to draw out here. Part of the reason that they went to the urgent care center was consideration of their co-pay and deductible. The author mentions a RAND study from 25 years ago that resulted in the nearly universal insurance feature of the co-pay. The study’s

most potent finding was that people who got free care used 40% more services than did others assigned to cost-sharing plans. Yet the free care produced little measurable additional benefit for the average patient.

From this co-pay and deductibles grew and flourished

To discourage inappropriate care

However, you really need to key in on the “average patient” phrase and wonder for which patients there was “additional benefit” and is there a way to separate them from the group to ensure maximum benefit for each individual patient. Did “overutilization” save a life or cut down on morbidity for some individual?

The author goes on about the study:

Co-payments did discourage wasteful use…relatively non-urgent categories such as sprains and back pain were 47% less frequent in cost-sharing plans [hopefully not an aneurysm causing the “non-urgent” back pain]. Unfortunately, co-payments also discouraged appropriate use…Most patients cannot reliably distinguish appropriate from inappropriate ER use [particularly at the time of the pain/symptom]…

Co-payments and other cost-sharing, which insurance companies and purchasers of insurance are pushing to new highs, can and do contribute to health crises and, even, death. This “remedy” for rising health insurance premium costs is a failure and worse, can be a cause of death. Our current system needs an overhaul at least or replacement with something better for all concerned.

The travails of cocaine use (ultimately death)

2008-12-12T17:04:00.002-06:00

Probably of more interest to people who don’t read my blog, but:

The price of a gram of cocaine in the US soared 89 percent -- from 96.61 dollars to 182.73 dollars -- from January 2007 to September 2008, said the Drug Enforcement Administration (DEA) in a report.

…cocaine purity dropped during the same period from 67 percent to 46 percent

To increase profitability suppliers cut potency by mixing it with a wide variety of other substances -- an often dangerous practice.

Nonetheless key to remember: Cocaine kills, there is no safe amount of cocaine, you never know what you are getting/buying.

So now you have to spend more to die high; or maybe not quite high, if the amount is enough to kill you (or the adulterants a poisonous enough), but not quality cocaine enough to get a buzz on for you.

Teens speak up to stop deaths

2008-12-11T14:56:00.002-06:00

I was reading an editorial in a school newspaper recently (Stevenson High School Statesman, no link) and I thought I’d share a bit of it. I really liked it and I hope the students read it and take it to heart. (Someone recently suggested I should also get my message out in school newspapers, so this was a cool edition.)

The editorial’s head line is “Student silence on drug issue continues to create tragedies”. As is often the case with newspaper work, the first sentence and final paragraph sum up the editorial quite well:

As more students, families and communities become afflicted by the aftermath of excessive, and often uncontrolled, drug use, it’s time for Stevenson students to take a stand against future losses and a problem facing society right now.

Tell someone [about teen alcohol and/or drug use] before it is too late. Don’t lose a friend because you were worried about their reaction. Anger is temporary – death is not.

The editorial talks about friends being lost, death and tragedy, related to drug use and what a fellow student can do about it. Talk to the person, tell a counselor or faculty member personally or anonymously, use the “drop-in center”, talk to other friends, push to get them help. It is time we all did our part to stop this “death and tragedy”. Speak up. Speak out. It is not OK.

Anger is temporary – death is not.

(One last note: A talk I gave about teen drug and alcohol use and comments I made during an interview are featured in a front page article, the students involved in all this are to be commended.)

Contagious happiness

2008-12-05T16:00:00.002-06:00

Happiness is contagious, new study finds…

So suggests a new study proposing that happiness is transmitted through social networks, almost like a germ is spread through personal contact. The research was published Thursday in BMJ, a British medical journal.

Go out and infect someone this week end.

The uninsured are everywhere (and they are dying)

2008-12-04T12:11:00.002-06:00

From a Chicago tribune newsblog:

13.3 percent of 50 to 64 year old Illinoisans -- 287,084 adults -- are uninsured.

What I think would really surprise folks is that of those 287,000 uninsured folks only a quarter have incomes below the poverty line. We often dismiss the uninsured as folks who are low-income and disenfranchised in other ways as well. But the uninsured are folks just like you and me.

These are often folks who can’t get health insurance in the open market because of pre-existing medical conditions. Think about it, people who need health coverage the most are excluded. Therefore these folks will get/be sicker. Their health problems can affect the community as well. They will have increased use of the ER and emergent hospital use, which means more expensive healthcare for them and others who’s medical insurance and other payments pickup the tab for the unreimbursed care.

Something has to be done with the system now. The lack of healthcare coverage is hurting folks like you and me, it is dragging down the economy for a number of reasons, and we are seeing people dying as a result of our broken system. It needs to stop.

Want some more information? HCAN (Health Care for America Now): A great movement and good site of information.

Suicide Prevention Hotline mention

2008-12-01T15:00:00.003-06:00

News Sun 11-28-08

DART
Another sign of stressful times? The National Suicide Prevention Hotline (1-800-273-TALK), in business less than four years, has answered its one millionth call. Linked to 133 local crisis centers across the nation, it instantly links callers to a counselor closest to their location, 24/7. The hotline is also linked to a special service for veterans and their family members. Hey folks, it ain't that bad. Unless your a Wall Street broker, that is.

A bit flip at the end, but to paraphrase a saying "any time you can get you topic in the paper, it is a good thing". My letter in response:

Thanks for including information about the National Suicide Prevention Hotline in your “Darts& Laurels” November 28, 2008. We need to take advantage of every chance to get out information about suicide and that it is alright to reach out for help if you have thoughts of suicide.

Suicidal thoughts usually have antecedent depressive thoughts, but not always. Taking one’s own life can be an impulsive act on top of that depression, but there is often a time of thought and contemplation. If you can get a handle on that driving toward the “solution” of death, if you can expand your options, realize that there is another way, often death by suicide can be averted. That is what crisis lines are for. They can be quite effective.

Let’s hope that crisis lines can continue to exist in these times of budget cutting. Let’s hope folks realize they can reach out in that way and talk with someone who is willing to listen, help and give a bit of hope. It is often “that bad”. You are seeking deliverance from the pain you feel in your body, in your mind and in your psyche. Seek help. It is OK to get help. You are not “crazy”; seeking help does not mean you are crazy. Sometimes you just need help. National Suicide Prevention Hotline (1.800.273.8255 (TALK))

Richard L Keller, MD
Coroner

Fighting dementia

2008-11-20T16:52:00.002-06:00

They call the article “5 ways to keep Alzheimer’s away”, but it really talks about 6. After mentioning the recent Journal of the AMA article which found ginkgo biloba of no help in warding off dementia, it mentions others with some support.

Certainly, physical exercise and mental exercise are helpful and probably have the least conflicted evidence behind them, so they are easy to recommend. Physical exercise has been shown to keep folks sharp and to at least some extent improve established dementia. I also agree with the article that the mental exercise needs to be varied (“cross training” they call it, with the analogy of only doing pushups developing only the arms). Social interaction should also be included this category. It stimulates the mind and the body and is clearly good for the psyche, a trifecta of anti-dementia goodness.

Their other recommendations have a bit more checkered evidence backing them up. They recommend antioxidants (e.g. vitamins A, C, and E) which have some support, but overdoing them (particularly vitamins A and E) may not be good and may cause some harm. But do remember “all things in moderation”. Also recommended are phosphatidylserine supplementation, fish-oil supplements, and adding curry to your diet. I think the support is slim for these, but for the most part they are not likely to cause harm. I think the curry (e.g. in Indian food, one of my favorites) is a particularly fun and tasty way to work against dementia, so go for it.

Use-lose law; not OK to not enforce

2008-11-18T16:19:00.000-06:00

There was an article in the Chicago Tribune a couple of days ago about the “use-lose” law under which underage kids caught (and convicted of) drinking or being drunk have their driver’s license suspended for a short period of time (3 months with a first offense), even if driving was not involved in or around the drinking incident.

I think the law is an important step forward in limiting underage drinking and the deaths that result from underage drinking. Keep in mind that many of those deaths do not involve driving, nor do most incidents of date rape (alcohol is the number one date rape drug), but affecting their ability to drive will get their attention and is an effective punishment.

I think it borders on criminal that the enforcement of the law is inconsistent (the focus of the article) and think it is great that Lake County leads the state in enforcing the law. Let’s keep it up.

One comment irritated me:

"It is still going after the child, who is a victim of the alcohol industry," said Janet Williams, co-chairwoman of the Illinois Coalition to Stop Underage Drinking.

It is nonsense to think of these kids as victims. While I agree that some ads and some alcohol containing beverages are aimed at kids, it is wrong to write the kids off as (apparently) brainwashed victims. We can give kids the tools to resist this brainwashing if it is taking place at all (making something attractive doesn’t demand use). [The “brainwashing” if it is there at all is more following observed patterned behaviors of others.] We need to put information in their hands and in their heads about the effects of alcohol on their brains and the effects of alcohol on their lives (and deaths). It must be given to them truthfully, repeatedly and in various forms. Their parents and their schools and society must all do their part.

We must be consistent in communicating that underage drinking is not OK.

I will continue to do my part; you must get the information and do yours as well.

Make good choices, don’t take chances.

Crying for what's wrong with you

2008-11-14T14:37:00.001-06:00

We all have experienced that crying makes us feel better, but now there are studies that show that crying has health benefits as well.

It makes nine out of 10 people feel better, reduces stress, and may help to keep the body healthy. It's also free, available to almost everyone, and has no known side effects, other than wet tissues, red eyes and runny makeup. Crying may not be a blockbuster drug, but the latest research suggests it's highly effective at healing, and that it improves the mood of 88.8 per cent of weepers...

We cry out stress hormones. Crying stimulates the release of endogenous opiates for pain relief. Crying may help rebalance the body's electrolytes.

So treat yourself to a sad movie and have a good cry from time to time. It can help restore psychological and physiological balance in your life.

Being sad ain’t all bad.

Fun "health" facts

2008-11-06T16:34:00.002-06:00

I was reading the Chicago Tribune last Sunday and they had a fun fact list in a sidebar that they had gotten from “The Germ Freak’s Guide to Outwitting Colds and Flu’ and “Germ Proof Your Kids” I thought I’d share some of them:

3 feet: the distance droplets can travel after a cough of sneeze
20 feet: the distance fecal bacteria can travel from the toilet after it’s flushed

49: the number of germs, per square inch, on a toilet seat
25,000: the number of germs, per square inch, on an office telephone

Don’t you just love cool, mostly worthless “health” facts?

So don’t lick a phone at work.
However, knowing that you have “100 billion bacteria in your mouth”, maybe you wouldn’t notice.

Psychache

2008-10-28T14:19:00.002-05:00

A friend of mine recently sent me a link to a blog that had some interesting comments about suicide. I thought I’d post one such thought provoking paragraph:

In our average lives we say “I could never take my own life”. We say this from a safe place, able to deal with lifes ups and downs. THIS CAN AND DOES CHANGE. If we lack or lose the ability to handle our emotions, negativity and frustration step in. we start moving towards the spectrum of suicidal thought. we feel we are not coping and life becomes a struggle. The constant struggle seems endless. our needs are not met and we slowly slide into wishing it was all over.

In another place the author of the blog uses a great word (neologism) that fits suicidal thoughts (and other mental health issues) very well: psychache. (I warned them that I was going to use their word)

These are things we need to consider in working to prevent suicide, in working to get folks help that they need, and in understanding the problems that swirl around suicide and mental health. We must not only work to prevent suicide, but work to help them deal with their psychache.

and the elderly selling gravesites for cash...

2008-10-24T16:46:00.001-05:00

I thought the last post a bit strange and unsettling, then I saw this one (click through the ad in the link):

For some, a tough economy means hocking their possessions to raise cash. And not just furniture or jewelry. In lean times, even a person's final resting place is for sale.
Activity in the secondary market for burial plots has spiked in recent weeks, according to Bob Ward, who runs the Final Arrangements Network, an online marketplace for buyers and sellers of cemetery space. Most of those looking to sell: fixed-income seniors in their 60s and 70s.

New barometers of financial woes?

The dead evicted

2008-10-24T16:17:00.004-05:00

(These are busy times, sorry for the inconsistent posting.)

I came across this article and it struck me for several reasons, so I thought I’d share:

The bodies of five people and cremains for 22 others are on their way to a county medical examiner's office after the funeral home sending them to their place of rest was foreclosed on Friday morning.

Who knew there was a risk of eviction after death?

And then the interesting name of the funeral home (and crematory?):

House of Burns Memorial Chapel

Apparently funeral home staff declined to comment for the article:

"You don't want to let nobody know nothing — you just want gossip," the woman said, adding "have a blessed day" before hanging up.

I don’t bring this up to gossip. Can you imagine such an occurrence? The irony of no rest even for the dead, "have a blessed day" indeed. (I will close saying that they do seem to be handling this unfortunate situation well)

Increasing Suicide Rate

2008-10-21T14:01:00.003-05:00

After a decade-long decrease, U.S. suicide rates have started to rise, largely because of an increase in suicides among middle-aged white men and women

A new study out of Johns Hopkins demonstrates increasing suicide rates 1999 through 2005. It also seems to show that those in middle age are more at risk than previously thought. Historically, those at greatest risk were youth/young adults and seniors, but nationwide that age dipole is changing. For many years here in Lake County the ages have been more evenly spread, as has the geographic distribution over the county.

Just as the article wonders (linked here), it has certainly crossed my mind that the present economic “downturn” is likely to affect these demographics. It is early yet, but economics and other problems have always compounded the effects of depression to contribute to the risk of suicide.

Indeed:

"The key is getting people into treatment and getting people to use the resources that are available to them."

[Just a note: we will be sponsoring a site for a local broadcast of the annual American Foundation of Suicide Prevention (AFSP) National Survivors of Suicide Day event (Nov. 22, noon, Mundelein Fire Dept., 100 Midlothian Rd). Last year when we held the event it was a very interesting shared experience for all of the attendees and included an insightful local discussion.]

"Went to a Party Mom "

2008-10-15T11:48:00.001-05:00

I got this today in an email forwarded as a promotional for MADD (Mothers Against Drunk Drivers). Check them out; help them out if you can.

I have heard this read at pre-prom events several times. I can’t hear it or read it without getting choked up:

Went to a Party Mom

I went to a party,
And remembered what you said.
You told me not to drink, Mom,
so I had a sprite instead.

I felt proud of myself,
The way you said I would,
that I didn't drink and drive,
though some friends said I should.

I made a healthy choice,
And your advice to me was right.
The party finally ended,
and the kids drove out of sight.

I got into my car,
Sure to get home in one piece.
I never knew what was coming, Mom,
something I expected least.

Now I'm lying o n the pavement,
And I hear the policeman say,
the kid that caused this wreck was drunk, Mom, his voice seems far away.

My own blood's all around me,
As I try hard not to cry.
I can hear the paramedic say,
this girl is going to die.

I'm sure the guy had no idea,
While he was flying high.
Because he chose to drink and drive,
now I would have to die.

So why do people do it, Mom
Knowing that it ruins lives?
And now the pain is cutting me,
like a hundred stabbing knives.

Tell sister not to be afraid, Mom
Tell daddy to be brave.
And when I go to heaven,
put ' Mommy's Girl' on my grave.

Someone should have taught him,
That it's wrong to drink and drive.
Maybe if his parents had,
I'd still be alive.

My breath is getting shorter,
Mom I'm getting really scared
These are my final moments,
and I'm so unprepared.

I wish that you could hold me Mom,
As I lie here and die.
I wish that I could say, 'I love you, Mom!'
So I love you and good-bye.

Ceiling fan may help prevent SUID/SIDS

2008-10-10T14:00:00.001-05:00

We would all think it great to come up with another “simple” intervention to further lower the risk of SIDS (better termed SUID: Sudden Unexplained Infant Death). A recent study may have come up with such an intervention. The study showed that circulating the air in the infant’s bedroom with a ceiling fan (but not just having a window open) lowered the risk of SIDS death

So remember (and tell all new parents): “Back to Sleep”; firm mattress; minimal, non-downy blankets; no bumper pads, pillows or soft toys; keep them cool at night; and (apparently) install a ceiling fan.

Underage drinking is not OK

2008-10-08T15:25:00.003-05:00

I was part of a panel today talking about underage drinking, presented to a group of parents. We discussed its effects and its prevention, my portion was the effects of alcohol on the adolescent brain.

I led with a comment about an incident written about in the Chicago Tribune today. A limousine driver reported underage drinking among some teens he was driving for homecoming. He turned down a payoff attempt and did the right thing. My feeling is that he should get an award:

Limousine driver Leonel Cesar says he was just doing his job when he called police to report that a group of Highland Park teenagers tried to smuggle booze into his "party bus" on homecoming night

Later in the article was a comment about the “Safe Rides” program:

Similar debate surrounds the Safe Rides program in New Trier Township, which allows student volunteers to pick up their intoxicated peers from parties, no questions asked.

I will only contribute to the “debate” by relating a recent death here in Lake County (I did write about it shortly after it happened). I closed my part of the panel with a mention of the incident, as well. A young man (18 years old) was driven home after a party involving at least one “drinking game”. The young man later died of an alcohol overdose, his ride, while not part of the “Safe Ride” program, certainly did not have a safe outcome.

Underage drinking is not OK.

Don’t take chances. Make good choices.

Remains to Hungary

2008-10-07T17:08:00.001-05:00

Nice to report:

A young lady whose skeletalized remains were found May 12, 2007 is on her way to Hungary to be buried by her father. While it is quite likely she died of a drug overdose (drugs were found in the clothing she had on) we can really only conjecture because of the condition of her remains.

While it took a while to make all of the arrangements, we are finally able to reunite at least this part of the family (even in death)as her father wished.

Fake crack

2008-10-06T16:21:00.001-05:00

Whoa, a whole week without a post. Either I am slipping or I was as busy as I seemed.

Anyway, I came across an interesting article today checking out online "coroner news" (after participating in a panel on underage drinking information and prevention).

In Cincinnati they are apparently seeing an upsurge in “fake crack”. Now that is not something we have seen here (we have seen both fentanyl and diphenylamine masquerading as heroin, but not fake crack), but I thought it was interesting. We will certainly keep an eye out for it now, although it doesn’t seem very likely that users of fake crack will end up in our office:

Owens said that in recent days, up to 60 percent of the drugs sent to his office for testing on a given day turned out to be fake, usually made of high concentrations of vitamin B3.

Out Of The Darkness Walk

2008-09-26T11:06:00.002-05:00

Support the American Foundation for Suicide Awareness Out of the Darkness Walk October 4 with a donation or walking yourself:

WALK TO SAVE LIVES... In the United States, a person dies by suicide every 16 minutes, claiming more than 32,000 lives each year. It is estimated that an attempt is made every minute; with close to one million people attempting suicide annually.
By walking in the 2008 Out of the Darkness Community Walks to benefit the American Foundation for Suicide Prevention (AFSP), you will be walking with thousands of people nationwide to raise money for AFSP's vital research and education programs to prevent suicide and save lives, increase national awareness about depression and suicide, and assist survivors of suicide loss.

You can donate generally or if you want a specific team to support: “This Team is for Roo Joey Fischer” (If there are any other local teams, send me the info and I’ll put them up here)

Alcohol over-use kills

2008-09-25T13:39:00.000-05:00

I am preparing for a series of talks that I will be giving next month regarding the effects of alcohol on the adolescent brain. It will be part of a panel presentation regarding underage drinking prevention that a group is presenting at 4 sites. I have spoken on the effects of alcohol on the adolescent brain at several venues, so it is primarily a matter of fitting my presentation into the panel presentation.

Of interest to this note is that at one of the group meetings one of the others involved asked me to be sure to specifically mention “alcohol poisoning”. (We also discussed my including the fact that alcohol is the ‘number one’ date rape drug)

We don’t see alcohol overdose deaths in underage drinkers very often, most cases get intervention before they die. While it is an infrequent cause of death, we had one in our county this week. A young 18 year old man died of alcohol overdose (who, as fate would have it, went to high school with my daughter). My daughter described the memorial service to me last evening; many of his friends spoke highly of him and spoke of the tragedy of his death.

We often forget that alcohol kills, not just through car crashes, but because it is itself a toxin, a poison. Consumed in large enough quantities it can and does kill. Adolescents are particularly at risk because they tend to binge drink (5 or more drinks in rapid succession) and do not get the drowsiness shut off cue that most adults get.

The relatively new Illinois felony “social host” law will likely be invoked in this case: if great bodily harm or death results, the parent (host) faces possible imprisonment and possible significant fines.

Kids shouldn’t die when they are still kids
Think, don’t take chances, make good choices

Response to a query, hoping to help with information

2008-09-24T13:25:00.002-05:00

I thought this comment/email exchange might have answers of interest (and help) to others (related to Cocaine and Death):

My friend died last year and the autopsy listed Acute fulminant pulmonary edema & congestion, Acute visceral congestion,Moderate hepatomegaly, early CAD under findings. Under Toxicology, there were several drugs listed under Comprehensive Blood Drug Screen; Alprazolam: 15 ng/mL, Citalopram(trace)Cocaine(trace)Benzoylecgonine: 1760 ng/mL & Metoclopramide(trace). Under Comprehensive Urine Drug Screen, there were Alphahydroxyalprazolam, Citalopram, Cocaine, Cocaethylene, Benzoylecgonine, Hydrocodone, Metoclopramide, & Oxazepam. The cause of Death is listed under Accident(Acute Cocaine Toxicity). What is the signifigance of such a large amt of Benzoylecgonine? and it says there is only a trace of cocaine so why is death listed as cocaine toxicity? Some friends have said he wanted to die but I never got that impression from statements he made. He had recently been hosptitalized w/pneumnia and was on a respirator for 2 weeks two weeks before his death. Does it sound like the a high level of the Benzoylecgonine caused his death or the combination of all of the drugs?

Benzoylecgonine is the primary metabolic product from cocaine. It has a longer half-life (the time in which ½ of the substance is cleared from the body) than the parent compound, cocaine, 6 hours as opposed to half an hour. Cocaine also continues to be metabolized by blood cells even after death.

These results are consistent with cocaine-induced death. It is not unusual to find a “trace” of cocaine in the blood in such a situation. Most of those types of death are accidental in that folks tend to consume all of the cocaine they have available, not saving some for later.

Thank you for your response!I would like to ask a couple of more questions as there has been so many unanswered questions and I have had a hard time dealing with his death. He had struggled with his addictions the past couple of years;I think what got him started was the prescription narcotic pain medication he received for legitimate back & shoulder pain. When he ran out and couldn't get more, he would get cocaine or other drugs like oxycontin from "friends". I don't do drugs so it was hard to deal with but we had been in a relationship for several years so it's hard to just leave. I finally had enough and left a week before he died but I was still stopping by every day and he had a Drs appt scheduled the day after he died to try and get into a rehab program. I came home and found him sitting up slumped to the side with a pillow with uneaten food on it. I just thought he was sleeping so didn't try to "wake" him up right away. Our dog was sleeping on his feet. I finally tried to arouse him unsuccessfully and took his blood pressure with the machine his Dr had given him and it said -0- so i called 911. They told me to get him on the floor and try CPR. When I tried to move him, he fell on the floor and hot water squirted out from under his arms and there was really a bad smell all at once. They came really fast and worked on him in the ambulance for quite awhile unsuccessfully before they took him to the hospital but I found out later he was already dead when they got there and most likely had been dead when I got there. He was only 44 so I have been haunted by the vision of him sitting there ever since. He was depressed that I had left but he wanted me to come back and he told me on the phone that morning that he felt pretty good so I really don't think that he committed suicide but some of his friends seem to think he did because of the high levels of drugs. Everyone has their own theory and there has been so many ugly rumors since then, it has caused me alot of grief. One of his friends said he brought him over a 72 hour morphine patch which he sucked all of the juice out of;Another rumor is that he went into a seizure and his friends got scared and set him up the way I found him and left. I think everyone was afraid there would be a Police investigation but there wasn't much of an investigation. They made us leave(the dog too) for 4 hrs. The CSI team came and took some pictures and took all of his medicine and left. It definitely wasn't like the TV show. One of his aunts said there was rat poision in his system. I am having a hard time dealing with his death even though it's been a year now as I feel guilty because I left and wonder if he did, in fact committ suicide even though there wasn't a note.I am confused about the amt of benzoylecgonine. It is in the form ng/mL. How is that in relation to mg/ML? Is 1760 ng/mL really an abnormally large amt? Also, did he most likely smoke it or snort it? The last time I talked to him was 10:30am. I found him @ 2:30 pm when I thought he was sleeping. What was the most likely time of death? The medical examiner put the time he arrived at the hospital but from what the firemen and ems guys said, he was dead when they got to my house because he flat-lined on the machine and didn't have any blood pressure. Even though, the autopsy says accident, I still wonder if he took his own life. He always told me he would never do that, that only cowards would do that plus he had food on his lap and I don't think a person trying to kill theirself would bother to eat but I really don't know. To sum it up, based on this post and my previous post, do you think he committed suicide? What is the most likely time of death? Do you think he suffered? and is the amt of benzoylecgonine a lethal amt? also, how does the ng/mL convert to milligrams per Liter? I have been trying to move on but it has been very difficult. It would put my mind at ease if you could answer these questions even if they are not the answers I want to hear. Thank you so much for your help!

The morphine (or possibly fentanyl) from the patch would have shown up in the tox testing. There are several ways to extract drug from those transdermal patches, sucking on it being just one. It would appear that if it did occur, he didn’t receive a significant amount.

Seizure activity certainly can occur at the time of death and has scared away “friends” in other cases, especially if the death involves some illicit activities.

“Rat Poison” most often involves a blood thinner; signs of its overdose would have been present at autopsy. Arsenic requires special testing, but considering the other tox results I would think it is unlikely.

Cocaine is not a “usual” means of suicide, it is used recreationally and, as I have mentioned, often overused. He tox results are very consistent with any number of cocaine-related deaths. There is really no way, now, of knowing how he took in the cocaine. We often swab the nostrils and screen for the presence of cocaine to discern “snorting”.

I doubt he committed suicide, he likely over-used accidentally, likely died within a few hours of getting to the ER, likely did not suffer (died quickly), and died as result of cocaine intoxication with lethal levels found in his system (remembering, too, that there are no “safe” levels of cocaine).

[Google can help you with the units conversions]

Hang in there, death of friend (particularly a close friend) is often devastating, you will not “get over it”, but the pieces can come back together and your life will continue with the memory and the grief. You can handle it.

Near-death study

2008-09-24T11:20:00.001-05:00

I was sent a link to a Times article today:

A fellow at New York City's Weill Cornell Medical Center, Dr. Sam Parnia is one of the world's leading experts on the scientific study of death. Last week Parnia and his colleagues at the Human Consciousness Project announced their first major undertaking: a 3-year exploration of the biology behind "out-of-body" experiences. The study, known as AWARE (AWAreness during REsuscitation), involves the collaboration of 25 major medical centers through Europe, Canada and the U.S. and will examine some 1,500 survivors of cardiac arrest…

When your heart stops beating, there is no blood getting to your brain. And so what happens is that within about 10 sec., brain activity ceases - as you would imagine. Yet paradoxically, 10% or 20% of people who are then brought back to life from that period, which may be a few minutes or over an hour, will report having consciousness. So the key thing here is, Are these real, or is it some sort of illusion?

A point brought up in his interview was interesting because it actually went along with a discussion we were having in the office earlier today in discussing a recent death in our county. That point is that while we have the “social definition” of death being a moment, based on the “clinical definition” death is a process that occurs over time. While that process time is often very brief, there are times when it is prolonged. Not until the heart has stopped, breathing has stopped, and the brain has stopped functioning has death truly occurred. This is the crux of the discussion we were having, but to go a step beyond our discussion…

With these “near-death” experiences, do we also need to consider when the mind ceases to function as really defining death? As the interviewee states, most of the time the brain and mind are not separably observable phenomena, but on rare occasions we get a peek. The information that comes from this study will be interesting. Do we, as the article says, need new science to understand and study this? Will this “new science” give rise to the study of other phenomenology? This may be a first step.