Booster Shots

Oddities, musings and news from the health world

Category: death and dying

Taking Ecstasy too casually would appear to be unwise

June 10, 2010 |  4:06 pm

Ecstasy One death in L.A., two deaths in the San Francisco area, more than two dozen hospitalizations... It's possible -- just possible, mind you -- that Ecstasy might not always be the best party drug.

The L.A. Now blog reports Thursday on the Ecstasy-related downsides at two raves. It notes:

"One emergency-room patient suffered organ failure, requiring a stay in the intensive-care unit after suffering a seizure and liver and kidney failure. He needed dialysis to detoxify his blood, according to the report, and remained hospitalized for 28 days. The report said that, after his discharge, the man continued to need dialysis." Read the full post.

The L.A. Now details are drawn from a just-released Centers for Disease Control and Prevention report about a New Year's Eve rave. That report helpfully includes a definition of a rave.

And here's some information about Ecstasy, from the American Council for Drug Education. It includes street names, description, history, effects on the body -- even how it causes death. All good things to know.

-- Tami Dennis

Photo: Ecstasy is known in some circles as 3-4-Methylenedioxymethamphetamine -- or MDMA. Here, tablets are displayed after a U.S. customs seizure in L.A. in 2000.

Credit: Robert Gauthier / Los Angeles Times


Book Review: 'Passages in Caregiving' by Gail Sheehy

May 22, 2010 |  9:00 am

Book jacket of Passages in Caregiving-1 Caring for a loved one with a chronic illness -- a parent, partner, sibling or child -- is a role no one aspires to but many of us will take on.

In her superb new book, "Passages in Caregiving," Gail Sheehy writes that someone is serving as an unpaid family caregiver in almost one-third of American households. It's a job that lasts an average of five years.

"Nobody briefs us on all the services we are expected to perform when we take on this role," she writes.

That statement is no longer true, for "Passages in Caregiving" -- written from Sheehy's personal experience supplemented by a generous dose of reporting -- does it well. Her book outlines the road that awaits caregivers and gives practical advice to help them on the journey. It's an ambitious and readable blend of memoir, reportage, consumer advice, pep talk and love story.

Sheehy, author of the bestselling 1976 book "Passages" and many other books and articles, was married to Clay Felker, the legendary editor who founded New York magazine and cultivated such writing talents as Tom Wolfe, Jimmy Breslin and Gloria Steinem. They were a high-profile New York media couple with a life many would envy.

Then one day a phone call came that changed everything. It was a cancer diagnosis for Felker. As they absorbed the news and started making the rounds of doctors, Sheehy realized she had taken on a new role: family caretaker. She thought this would last six months to a year and then their life together would go back to normal. It didn't. 

Continue reading »

Near-death experiences: Can chemistry explain them?

April 9, 2010 |  3:08 pm

Wonderful-life The phenomenon known as "near-death experience" is the stuff of hospital dramas, a dramatic conceit for movies about do-overs and for a (I guess lucky) few of us, a mysterious peephole to "the other side."

The phenomenon is very real: By various estimates, 11% to 23% of those who had experienced cardiac arrest and lived to tell about it report some unique cognitive experience -- an overwhelming feeling of transcendence, doors opening, beckoning light, a thumbnail life-review -- that broadly fits the description. (The Internet yields a bounty of personal accounts as well, so it must be real!)

But their observations are not very well explained -- not, at least, by standard earthly measures.

A study appearing this week in the open-access British journal Critical Care offers an intriguing blood-chemistry analysis of the phenomenon, which may point to further avenues of research.

Researchers from University of Maribor's School of Medicine in Slovenia followed 52 patients in Slovenia who had suffered out-of-hospital cardiac arrests, were resuscitated after they had ceased breathing and lost a pulse, and survived. Eleven of the 52 patients -- aged on average 53 years and 42 of whom were male -- reported having had a near-death experience. The researchers compared the 11 patients whose recalled experiences measured at least a seven on a possible 33-point scale measuring near-death experience (yes, there is such a thing).

Near-death experiences were significantly more likely to have been recalled by survivors who, within five minutes of their arrival at the hospital, had higher concentrations of carbon dioxide in arterial blood and higher blood-potassium levels, the Slovenian physicians found. At least as important is what factors were not associated with a higher likelihood of a patient having had the near-death experience: Researchers found no link between near-death experience and patients' religious belief, fear of death, education level, age, sex, time elapsed until resuscitation or drugs administered during resuscitation. They also looked for links to patients' sodium levels -- another critical piece of blood chemistry -- and found none.

The mystery of near-death experiences, of course, is very far from answered here. One thing we don't know -- and I'd venture to claim will never be known -- is how many and which of the heart attack victims that failed to survive also had a near-death experience before dying. One 2007 study found that low blood levels of potassium in patients with heart failure, for instance, is associated with a higher risk of death. Possibly, patients with higher carbon dioxide and potassium levels who had had near-death experiences were simply more likely to survive to recount the sensation.

And then there's the simple fact that many people have described cognitive disturbances that could readily be mistaken for near-death experiences when they were not (technically) near death: fighter pilots have described such experiences under the influence of high G-forces; patients anesthetized for surgery have reported similar experiences -- as have, of course, psychotic patients. There's a fine overview of all the vagaries of the near-death experience here.

So, have you had a near-death experience? Please share!

-- Melissa Healy

Photo: In Frank Capra's 1946 film "It's a Wonderful Life," George Bailey gains a greater appreciation for life once he sees what it would have been like if he never existed. Credit: Reuters


It's hard to predict what a person's last year of life will be like

April 1, 2010 | 10:47 am

Oldage It's natural to assume that we see death coming in old age; that we slow down, become disabled and then die. But that's not necessarily the case, according to an enlightening study published Thursday in the New England Journal of Medicine.

Researchers identified five distinct trajectories in the last year of life -- no disability, catastrophic disability, accelerated disability, progressive disability and persistently severe disability. But they found these trajectories varied widely among people and their conditions. Only advanced dementia was really predictable. Those people had high levels of disability throughout the last year of life.

For five other categories (cancer, organ failure, frailty, sudden death and other conditions), from 26.8% to 80% of people were not disabled or had very low levels of disability until only a few months before death. Overall, more than half of the 383 study participants were not disabled 12 months before death. A high number of people who died of cancer, for example, were not disabled during the last year of life.

"These results indicate that for most decedents the course of disability at the end of life does not follow a predictable pattern based on the condition leading to death," the authors, from Yale University School of Medicine, wrote.

The study raises some important points. First, for policymakers, it's hard to know how to allocate resources for healthcare services when disability varies so much in the last year of life. Second, for patients and families, the unpredictable nature of this final year suggests the need to plan for a variety of scenarios. Another study, also in the current issue of the New England Journal of Medicine, found that advance directives, documents that specify the kind of medical care desired, or not desired, at the end of life, work fairly well and are valued by patients and their families. Given the unpredictability of the last year, it seems prudent to have an advance directive prepared in old age, no matter how good you're feeling.

For more on end-of-life care, see this recent L.A. Times Health section.

-- Shari Roan

Photo by Justin Sullivan / Getty Images


The death of a word: euthanasia

March 29, 2010 |  9:03 am

Euthanasia People disagree vehemently on issues surrounding death and dying, such as what palliative and medical measures can be appropriately taken at the end of life. But use of the term "euthanasia" doesn't advance the intelligent discussion of end-of-life care, say editors of the Canadian Medical Assn. Journal.

In a commentary published Monday, Dr. Paul C. Hébert and Dr. Ken Flegel argue that the meaning of euthanasia "has become frayed and torn. It mixes ideas and values that confound the debate about dying. It is time to discard it."

Euthanasia originally conveyed the idea of a gentle death. The term eventually evolved and took on another meaning: actions that bring about a gentle death. According to the authors, however, the meaning of the term has broadened further -- and has become clouded -- to encompass actions that involve providing relief to dying people. For example, a survey of doctors in Quebec last year found that 81% said they had practiced euthanasia, and that 48% said palliative sedation -- in which medication is given to provide comfort but which may hasten death -- can be likened to euthanasia.

That's the wrong interpretation, Hebert and Flegel write, saying that "...administering enough narcotics to relieve pain in patients with cancer and adding enough sedation to enable comfort and minimize agitation is appropriate and compassionate care, even when the amounts required increase the probability of death."

Instead of calling such an action euthanasia, health professionals should avoid terms that mean different things to different people, the editorial states. Instead, it advises, doctors should describe their proposed action and its intention and avoid loaded words.

-- Shari Roan

Photo credit: Eric Boyd / Los Angeles Times


Smile your way to a long life

March 25, 2010 |  6:00 am

People who smile a lot are usually happier, have more stable personalities, more stable marriages, better cognitive skills and better interpersonal skills, according to research. Science has just uncovered another benefit of a happy face. People who have big smiles live longer.

Vladdy Researchers at Wayne State University used information from the Baseball Register to look a photos of 230 players who debuted in professional baseball before 1950. The players' photos were enlarged and a rating of their smile intensity was made (big smile, no smile, partial smile). The players' smile ratings were compared with data from deaths that occurred 2006 and 2009. The researchers then corrected their analysis to account for other factors associated with longevity, such as body mass index, career length, career precocity and college attendance.

For those players who had died, the researchers found longevity ranged from an average of 72.9 years for players with no smiles (63 players), to 75 years for players with partial smiles (64 players) to 79.9 years for players with big smiles (23 players).

This isn't a bunch of psycho-hooey, the authors said. Smiles reflect positive emotion. Positive emotion has been linked to both physical and mental well-being. They added a caveat to their study, noting: "The data source provided no information as to whether expressions were spontaneous or in response to a photographer's request to smile." Still, big smiles are more likely to reflect true happiness than partial smiles.

What I'm wondering is, did they account for each team's winning records? Maybe the non-smilers were thinking about batting averages.

The study is published in the journal Psychological Science.

-- Shari Roan

Photo: Former Los Angeles Angels' player Vladimir Guerrero is known for his beatific smile. Credit: Alex Gallardo  /  Los Angeles Times


If your child were dying of cancer, would you consider hastening his or her death?

March 1, 2010 |  1:01 pm

Experts estimate that 2% to 10% of adults with terminal illness ask their doctors about medications they could take that would hasten their death. Researchers at the Dana Farber Cancer Institute in Boston and their colleagues wondered what the equivalent figure was for pediatric cancer patients with only weeks or months left to live.

Grave So the researchers interviewed 141 parents whose own children had died of cancer. The survey found:

  • 13% had considered taking measures to hasten their child’s death
  • 9% actually discussed the possibility of hastening death
  • 4% asked doctors for medications that would end their child's life sooner
  • 2% said they had used morphine to hasten their child’s death

In general, parents were more likely to consider taking action if their child was in a great deal of pain. In fact, 34% of the parents surveyed said they would have considered hastening their own child’s death if he or she were suffering from uncontrollable pain.

The results were published Monday in the Archives of Pediatrics and Adolescent Medicine.

— Karen Kaplan

Photo credit: Mandel Ngan/AFP/Getty Images



Breaking through the silence of the seemingly unconscious: Researchers read minds of the vegetative

February 4, 2010 |  9:38 am

British neuroscientist Martin Monti says he and his colleagues were "absolutely stunned" as they began to discover that by reading images of patients' brains while those patients were asked questions, the researchers could not only detect signs of life in the minds of patients thought to be vegetative, they could enable a patient locked in by injury to communicate.

Monti is the lead author of a widely hailed study published Wednesday in the New England Journal of Medicine's Early Online edition and detailed in an article here. In an interview, he described the process by which he and colleagues in Cambridge, Britain, and Liege, Belgium, broke through the silence of five grievously brain-injured patients who had been diagnosed as "vegetative" or (in one case) "minimally conscious."

Although those diagnoses assume that a patient is "wakeful without awareness," Monti and colleagues found that of 54 patients they tested, five were aware enough to respond to instructions to imagine playing tennis. Those patients responded with brain activity that looked just like that of healthy people thinking the same thing. Four of the vegetative patients showed brain activity suggesting the same level of awareness and intent when researchers asked them to imagine walking through the rooms of their home.

In one patient, then a 22-year-old man who had been thought vegetative since a car accident five years earlier, the researchers devised a way to get him to answer yes-or-no questions. By thinking about playing tennis, he responded -- correctly -- that, yes, one name provided by researcher was his father's first name. And by imagining navigating the rooms of his home, he responded "no" to simple questions about his siblings and family.

Monti said the researchers hope to use the technique to explore the minds of other "locked in" patients, such as those with amyotrophic lateral sclerosis, or Lou Gehrig's disease -- and to explore simpler techniques, such as EEGs to detect intent and awareness in patients thought to be vegetative.

He also said they hope to see the young man, now in his late 20s, again and use their brain-imaging techniques to communicate further with him. He said he is not haunted by the idea that, having seen flickering signs of mental life in the young man known as Subject No. 23, the researchers had to send him back to his silent world.

"I am proud we could give him a chance to tell us he was conscious, and to interact with his environment," said Monti, who said he hopes that techniques like those described in the study can be used to help patients tell their caregivers if they are in pain or distress. He added that the technique should improve the precision and accuracy of the techniques now used to diagnose patients who are unresponsive after head injury or illness that has blocked the flow of oxygen to their brains.

UCLA neuroscientist David A. Hovda, commenting on the study, noted that all but one of the patients who responded to the British-Belgian research team were young -- in their 20s -- and all of those who responded had suffered traumatic brain injury rather than stroke or illness that shut off the flow of oxygen to their brains.

That finding, he said, underscores two important things that the families of unresponsive patients will need to keep in mind: that traumatic brain injury, which kills 50,000 people a year and has left about 5.3 million Americans disabled, behaves differently from conditions that block oxygen flow to the brain, and may leave patients with more residual mental activity; and that younger brains are probably more resilient in the wake of injury than are older brains and may be more likely to show signs of awareness.

-- Melissa Healy

 


When should doctors talk about death?

January 11, 2010 |  6:00 am

Doctors should discuss end-of-life issues with their patients when they are terminally ill with less than one year to live, according to formal recommendations. But many doctors are reluctant to initiate such talks until patients are late in the course of the illness, according to a new study.

EndoflifeEnd-of-life issues include such important points as prognosis and preferences for resuscitation, hospice care and where patients would like to die. Some studies suggest that people who have these discussions with their doctors have better experiences with death. Researchers led by Dr. Nancy Keating at Brigham and Women's Hospital and Harvard Medical School surveyed 4,074 doctors about end-of-life discussions with cancer patients who had four to six months to live but were currently feeling well.

Only 44% of the doctors said they would be willing to discuss resuscitation while the patient was still feeling well and only 26% would discuss hospice. Instead, they would wait until patients felt worse or no more treatment options were available. The study is published online today in the journal Cancer.

It could be that doctors don't want to bother with difficult and time-consuming end-of-life discussions when there is still time left to talk about these issues later. Or it could be doctors disagree with the recommendations to initiate such discussions. Moreover, little is known about patients' preferences regarding the timing of these discussions. Some studies show patients think doctors are giving up on them if they raise end-of-life issues. Others say they would prefer that doctors are candid and give them and their families plenty of time to plan.

The dilemma for doctors is obvious. But patients can take matters into their own hands by initiating the discussion. Plenty of materials are available to help people who are terminally ill and their families prepare. See:

-- Shari Roan

Photo credit: Steve Helber / AP 


No CPR training? No problem!

December 23, 2009 | 12:52 pm
Cpr To all you would-be good Samaritans out there: if someone looks like they're in need of mouth-to-mouth, but you don't have CPR training, call emergency services and they will guide you through it. Odds are, it won't hurt.

That’s according to a study published online Monday in the journal Circulation. Study co-author Thomas Rea of King County’s emergency services division said the survey came about because of an observation that bystanders were not performing CPR as frequently as they could have. “There's reticence and fear on the part of the bystander — and the dispatcher — that they may cause injury to the victim,” Rea said in an interview.

Researchers from the University of Washington and King County emergency services examined 1,700 calls made between June 2004 and January 2007 in which an emergency dispatcher directed a caller on how to perform CPR over the phone. Of those 1,700 incidents, more than half (938) of the subjects were determined to be in cardiac arrest – so those first clumsy chest compressions may have helped sustain the patient until paramedics arrived. The other 762 were found to not be in arrest at the time. For the 247 who weren't actually in cardiac arrest but did, for some reason, receive chest compressions, 12% (29 people) "experienced discomfort," and 2% (six people) were injured, possibly as a result of the well meaning bystander's ministrations. Five people sustained fractures, but nothing more serious than that. 

In that time period, there were likely a total of about 4,000 calls relating to possible cardiac arrest, Rea said.

So given the potential for saving lives, if you think someone is in arrest, amateur CPR is worth the rare possibility of a cracked rib. But if you want to make sure you know the symptoms of a heart attack, the American Heart Assn. gives a helpful primer.  If you want to read up on how to perform CPR, just in case, click here

-- Amina Khan

Photo credit: John M. Glionna / Los Angeles Times



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