Heath Ledger is dead at 28. How many times can we do this type of Celebrity Illness column?
It is getting tiresome and terribly depressing to try and surmise what drug combination caused to the demise of such a young and talented person. The question we often ask ourselves is why som many of these actors and musicians display such high-risk behavior.
Ultimately, they will conclude that a combination of different medications and possibly narcotic (probably heroin) caused the death of Heath Ledger. There is no secret and no interesting differential to discuss here. For all of the details of the ongoing investigation read below.
“According to the police, at about 12:30 p.m., a housekeeper, Teresa Solomon, arrived at the apartment, at 421 Broome Street in SoHo, to do household chores. At about 1 p.m., she went into Mr. Ledger’s bedroom to change a light bulb in an adjacent bathroom; she found him on the bed face down, with the sheet pulled up to his shoulders, and heard him snoring.
A masseuse, Diana Wolozin, arrived to give Mr. Ledger a massage at about 2:45 p.m. At 3 p.m., after Mr. Ledger did not emerge from his bedroom, with the door closed, the masseuse called him on his cellphone but got no answer. She saw him laying in bed. She took a massage table out of the closet and began to set it up near his bed. She then went over to him and shook him, but got no response. Using his cellphone, she used a speed-dial button to call Mary-Kate Olsen in California to seek her guidance, knowing Ms. Olsen to be a friend of Mr. Ledger’s. She told Ms. Olsen that Mr. Ledger was unconscious. Ms. Olsen said she would call some private security people she knew in New York, and hung up. Ms. Wolozin again shook Mr. Ledger, called Ms. Olsen a second time, and said she believed the situation was grave and would call 911.
Ms. Wolozin called 911 at 3:26 p.m. to say that Mr. Ledger was not breathing. The call occurred less than 15 minutes since she had first seen him in bed and only a few moments after the first call to Ms. Olsen. The 911 operator urged Ms. Wolozin to try to revive Mr. Ledger, but Ms. Wolozin’s efforts were not successful.
Emergency medical workers arrived at 3:33 p.m., at almost exactly the same moment as a private security guard summoned by Ms. Olsen. The medical workers moved his body to the floor and then used a defibrillator and CPR, to no avail. Mr. Ledger was pronounced dead at 3:36 p.m. By that point, two other private security guards summoned by Ms. Olsen had arrived, as had police officers.
The police said that all five witnesses — Ms. Solomon, the housekeeper; Ms. Wolozin, the masseuse; and the three private security guards summoned by Ms. Olsen — were fully cooperating with the authorities.”
2008-01-24
That lucky hockey player in the middle is Richard Zednick. He is being helped off the ice after sustaining one of the worst Celebrity Illness injuries we have ever reported.
According to several sources, Zednik was circling the net behind the play and skating into the corner when Olli Jokinen was upended by Sabres forward Clarke MacArthur. Jokinen fell headfirst to the ice, and his right leg and skate flew up and struck Zednik directly on the side of the neck, slicing his right carotid artery.
While several news sources are reporting that the injury nearly hti his jugular vein, we in the medical industry know that the high pressure pulsatile flow of the carotid artery is a much more dangerous vessel to traumatize.
Zednick suffered significant blood loss and managed to skate almost the entire length of the ice before basically collapsing into his trainer’s arms.
The brave puck head was rushed to Buffalo General Hospital where he is currently recuperating in the SICU after surgery to repair the artery.
2008-02-13
Despite the appearance of physical health - at least, until she shaved her head - Britney is not well. To enlighten our writers and readers we decided to enlist the help of an Ivy League-trained clincal psychologist for this special edition of Celebrity Illness. Enjoy.
1. Substance Abuse Disorder - Addiction. That’s right, you guessed it. Like we said about so many young celebs in this article: if it smells like drugs, and looks like drugs…. it’s drugs! Coke, Meth, Crack, X, Alcohol…whatever. That’s my call.
2. Borderline Personality with Psychotic Features - Altogether likely. Given the labile mood, strange and extreme behavior and chronic emptiness coupled and with pre-morbid narcissism, pattern of unstable relationships and shallow affect, BPD with psychotic features is definitely a contender for the diagnosis. It is almost a requirement for to be a Hollywood/performer type.
3. Psychotic Disorder NOS - Purely based on strange behavior and poor judgment, we don’t actually know if she has lost touch with reality (like hearing voices, seeing and/or smelling things, delusions). Unlikely since she is a bit old for a psychotic break..though still within the age range for women.
4. Postpartum Depression with Psychotic features - Britney did just have a child within the past six months so we can’t totally remove it from the differential; it is unlikely because this diagnosis is usually diagnosed within the first 6 weeks postpartum…and it is kind of like she doesn’t have any children at all…so what is she depressed about? Hormones.
5. Bipolar Disorder - High on the differential because it is so hot and hip these days with the famous set. Britney’s impulsive behavior..partying (i.e. self-medicating), flying all over the country, checking in and out of rehab within a day, hyper -sexuality, shopping, irritability. True bipolar will generally see an approx 3 months manic period followed by deep depressive period for approx 9 months. So, we could be in the downward spiral anytime.
2007-02-19
An unlucky employee of Wolfgang Puck Catering diagnosed with hepatitis A may have donated his virus to guests at several high-profile functions, including Sports Illustrated’s swimsuit issue party attended by Beyonce Knowles and other pseudo-celebs, officials said.
The risk of illness was ‘quite low,’ but anyone who ate raw food at the magazine’s Feb. 14 party was urged to receive a preventive shot by Wednesday, the LA County Department of Public Health said Tuesday.
The affected employee was placed on medical leave, said Carl Schuster, president of Wolfgang Puck Catering.
‘We immediately worked to take every precaution to further safeguard our patrons and other employees,’ Schuster said in a statement.
Sports Illustrated said in a statement that it was taking the situation very seriously and was working directly with county health authorities.
‘We are alerting our guests and staff as quickly as possible to ensure they receive the relevant health warnings,’ the statement said.
Hep A (HAV) is usually spread via the fecal-oral route, i.e. infected people share the yellowing virus through food and water that they handle – after touching their ass. It is more prevalent in low socioeconomic areas in which a lack of adequate sanitation and poor hygienic practices facilitate spread of the infection.
To get technical on your ass, (and for those of you prepping for Boards) Hepatitis A is a 27 nm, nonenveloped, icosahedral, positive-stranded RNA virus classified in the Heparnavirus genus of the Picornaviridae. But you knew that.
According to our favorite medical resource, UpToDate.com, community outbreaks due to contaminated water or food have also been described, shellfish being the most popular offender. However, several outbreaks related to consumption of “contaminated” green onions have been reported in the literature.
HAV infection usually results in an acute, self-limited illness and only rarely leads to fulminant hepatic failure.
The two most common physical examination findings are jaundice and hepatomegaly, which occur in 70% and 80% of symptomatic patients, respectively. Less common findings include splenomegaly, cervical lymphadenopathy, evanescent rash, arthritis, and, rarely, a leukocytoclastic vasculitis.
Laboratory findings in symptomatic patients are notable for marked elevations of LFTs (usually >1000 IU/dL), serum total and direct bili, and alk phos. Typically, ALT is higher than the AST and bilirubin levels above 10 mg/dL are not uncommon.
The diagnosis of acute HAV infection is made by the detection of anti-HAV antibodies in a patient with the typical clinical presentation. Serum IgM anti-HAV is the gold standard for the detection of acute illness.
Because the disease is usually self-limited, the treatment is supportive.
But believe us, it would be a lot more than supportive if one of the celebs turned yellow.
2007-03-03
For just over two hours this past weekend, Dick Cheney was your President. The reason? Dubya was having 5 hyperplastic polyps removed from his colon.
Typically, conscious sedation (e.g. Versed or Fentanyl) is administered for a screening colonoscopy since most people find it unpleasant to have a camera-headed tube inserted into their anus and advanced through their colon.
Nearly as uncomfortable is the “colon prep” that must be taken the night before to make sure the inside of the gut is clean for viewing. Most often, patients in Bush’s situation are given a jug of liquid like GoLytely to drink the night before the procedure and a clear liquid diet. This often induces a significant amount of toilet time the night prior to the study – which is sort of comical to think of in the setting of our President.
Since Bush was temporarily incapacitated by the sedation meds, he transferred power over to VP Cheney for 125 minutes. Thankfully, it was an uneventful couple of hours.
Turns out that Bush had 5 polyps removed from his colon and all of them were benign. The 61-year-old President will have his next colon cancer screening in 3 years.
Ironically, Bush’s health news was delivered by Tony Snow, who is undergoing chemotherapy for recurrent and metastatic colon cancer after having a large segment of colon removed in 2005.
2007-07-25
Add another item to Dick Cheney’s long list of medical issues. In addition to his 4 heart attacks (first being at a sprite 37 yrs of age), 2 bypass surgeries, multiple coronary interventions, popliteal aneurysms, ischemic cardiomyopathy, and subsequent implantation of a cardiac defibrillator - the vasculopath has staved off death yet again.
The cat-like veep has amazing luck or a ridiculously attentive medical staff. Following an around-the-world trip which included more than 60 hrs of air travel, Cheney complained of slight calf pain which elucidated the DVT.
Cheney visited his doc at George Washington University hospital and a duplex revealed the clot, prompting his MD to start him on warfarin. In a statement today, Mr. Cheney’s office said he would be treated with “blood thinning medication for several months.”
We can only assume that Cheney is already on standard anti-platelet therapy, aspirin and Plavix, considering his multiple stent history. Throw in some warfarin for this latest diagnosis and his blood will be “thinner” than Nicole Richie. Speaking of “thin blood”, why do we use this euphemism and who came up with it? The blood’s viscosity does not change at all. Is it really that hard to explain or understand that platelets help clots to form and these medications prevent the bonding of platelets to each other? It is due time that the media and PR flack start speaking of medical treatments in real terms rather than 3rd grade metaphors. If advertisors can advertise directly to consumers than consumers should understand medical terminology rather than psedo-scientific analogies.
Back to Cheney’s hard-to-believe medical history, Dr. Cameron Akbari, a senior vascular surgeon at Washington Hospital Center in the District of Columbia, said Mr. Cheney’s history of heart disease puts him at only “a very slightly increased risk” of developing a deep venous thrombosis.
“Reasons No. 1, 2, 3, 4 and 5 why he developed this are he was on a very long plane ride,” Dr. Akbari said.
Ok. But why does he keep clotting every portion of his vascular bed. I am quite sure that Cheney has had the over-ordered hypercoagulable work-up, but he should also be tested for aspirin and clopidogrel resistance.
To clarify, it is unlikely that the clot lodged in Cheney’s left leg is actually sitting in his calf. The vast majority of these thrombi sit in the larger, more proximal venous system. And lastly, Coumadin or Warfarin, will prevent further propagation of this clot but will not dissolve the clot - so the risk of PE is still there all you anti-Chenites.
One more interesting historical note: Warfarin was named in honor of the Wisconsin Alumni Research Foundation who discovered that coumarin, a byproduct of moldy silage, was a potent anticoagulant and the cause of bleeding cows. Warfarin was first registered for use as a rodenticide in the US in 1952, but its true mechanism of action, the inhibtion of vitamin K-dependent cofactors was not elucidated until 1978.
2007-03-06
The Associated Press is reporting that Johnny Depp’s 7-year-old daughter with longterm partner Vanessa Paradis is “doing much better” after a nine day hospital stay in London.
Several articles report that Lilly Rose was originally admitted for “blood poisoning” after stepping on a rusty nail at Depp’s country home.
We decipher “blood poisoning” to mean bacterial infection disseminated to the blood causing a sepsis like picture. And considering the circumstances, i.e. rusty nail, one would have to assume that the offending bug would be Clostridium tetani, or tetanus. Or is it?
Actually, probably not. While more than 90% of pedal puncture wounds result from stepping on a nail. The most common organisms implicated in penetrating wounds are Staph aureus, beta-hemolytic streptococci, and then various anaerobic bacteria. Also, Pseudomonas aeruginosa is often responsible for infection when the injury is due to object penetration through shoes and socks.
Importantly, puncture wounds have the capability to infect deep spaces of the foot, including bones, joints, tendons, and deep fascia, and serious complications can arise. Therefore, the depth of penetration is hugely important.
The signs of more extensive injury are those typical of any infection, i.e. redness, warmth, pain, and swelling. If the offending object is still partly in there, e.g. broken glass or sea shell, it must be removed and the wound must be extensively debrided. Empiric ABx should be started to cover the most common bugs, i.e. S. aureus but anti-pseduomonals should be strongly considered as psudomonal osteomyelitis/-chondritis can be catastrophic.
It is our suspicion that Depp’s daughter probably was treated inadequately or conservatively at first or perhaps even his the injury from her parents as kids can do and then presented 2-3 days after the injury with a warm, red, swollen foot. Imaging studies were performed for sure which included plain old x-rays to look for air and possibly a CT. CBC, Chem, and ESR were quite important in documenting infection and blood cultures were probably being sent every time the little one spiked a fever.
When she manifested systemic evidence of infection, broad spectrum IV antibiotics were certainly started and the wound was opened, any pus was removed, and the wound was most likely left open to heal on its own rather than sew it shut again.
Typically, in systemic bacterial infection, i.e. bacteria in the blood (bacteremia) patients will experience signs of sepsis: hypotension, tachycardia, fever, increased WBC. In addition to stroing anti-microbial therapy, IV fluids were probably used and maybe even pressors for blood pressure support.
This is a very scary situation for a little girl and her parents. We are happy to hear that she is out of the hospital and recovering. An interesting infectious disease topic nevertheless which proves our mantra: It sucks to be an interesting patient, but it’s great to have an uneventful recovery.
Baldwin G, Colbourne M: Puncture wounds. Pediatr Rev 1999 Jan; 20(1): 21-3[Medline].
Patzakis MJ, Wilkins J, Brien WW, Carter VS: Wound site as a predictor of complications following deep nail punctures to the foot. West J Med 1989 May; 150(5): 545-7[Medline].
2007-03-10
Celebrity tak show host Regis Philbin dropped a bomb on his audience yesterday when he informed them that he would soon undergo coronary artery bypass surgery (CABG).
“I got to do it,” Philbin said at the start of “Live With Regis & Kelly.” “Darn it, I don’t want to do it. Nobody wants to do it, I guess.”
The diminutive but spry 75 yo male had been on a short hiatus, most likely to evaluate some ongoing chest pain issues that he had admitted to: “I had been feeling chest pains, you know, and, uh, shortness of breath and all those little symptoms that you hear about.”
Philbin’s refreshing candor about such a serious operation will most likely go a long way to educating his viewers about coronary artery disease and its treatment options. It also cuts out a lot of the investigative and speculative fun of our Celebrity Illness article, but don’t worry, there’s plenty to discuss.
Reege, as he is affectionately known, most likely presented to his PMD with c/o chest pain and fatigue and who knows what else. The guy is a huge college football fan and constantly boasts about his superior physical shape which will serve him well during this process.
Upon hearing his symptoms, it is possible that Reege was sent directly for cath, (i.e. cardiac catheterization) but more likely had a exercise-nuclear stress test first which should have suggested significant ischemia. Either way, coronary angiography was performed.
Why isn’t he going for stent you ask? Currently, there are only a few hard and fast indications for CABG: 1) Left main (LM) coronary artery blockage >50%; 2)Triple vessel disease or 2-vessel disease involving the early portion of the left anterior descending artery (LAD).
If it was the former, there would have been no discussion and Reege would have most likely already been on the OR table by now. Thus, it is much more likely that he has stable multivessel disease and will have a left internal mammary artery (LIMA) graft to the LAD as well as some saphenous vein grafts harvested form his legs.
Coronary artery bypass graft surgery is associated with significant morbidity. Major complications include death, myocardial infarction (MI), stroke, wound infection, prolonged requirement for mechanical ventilation, acute renal failure, and bleeding requiring reoperation. This doesn’t even include the nearly 50% incidence of post-op atrial fibrillation and all fo the complications inherent in AF. Using registry data in the United States, the perioperative and in-hospital mortality rate after CABG averages about 1% for the lowest risk elective patients, and 2-5% for all patients.
There are a few risk-predicting algorithms as outcome is hinged on comorbids but we’re not gonna go there. Here are some factors that have a major impact on survival and complications:
- Pre-op LV function
- Age
- Kidney function
- Coronary diameter
- Operator experience
Are we getting too data-y for you? It’s a tough surgery and you should know this before you send patients (or go for it as a patient) for what has become thought of as a fairly routine deal. It is also important to keep in mind that it has amazing benefits in almost 98% of patients.
Philbin will be facing a difficult recovery as his sternum will be sawed open to expose the heart and although he will be under general anesthesia at the time - he hopefully won’t stay that way. After the recovery room, he’ll be monitored in a special cardiac surgery ICU where they will hope to extubate him as soon as he can tolerate it. He will also have chest tubes and a pericardial drain following the surgery, all which will hopefully come out after POD#3. He should be out of the hospital b/n 5-7 days where he will gently recuperate and be maintained on good pain meds.
After about a month, Reege will be able to get his groove on again and we predict a late April/early May return for the daytime maven of talk.
We wish Philbin a speedy recovery and hope that he uses this opportunity to educate his audience about his experience and the preventive measures that can take in order to avoid a similar prognosis.
2007-03-13
Someone above was looking out for StopPagingMe.com. We have been looking for an excuse to talk about the upcoming American Idol finale between the Keane-like, beat-boxing Blake and the smiley, It-factor-laden Jordin Sparks.
Our excuse to come clean about our Idol affinity came in the form of a broken nose. Not just any nose either, the nose of our favorite supportive and sedated judge, Paula!
According to numerous reports, the oft-slurring Abdul was trying to avoid her dog and wound up taking a nasty spill, telling Extra that she tore cartilage in her nose and broke a toe. Ouch! The dog was okay, though.
Paula has a well-documented history history of pain killer affinity so hopefully she was premedicated.
Getting medical though, schnoz fracture is the 3rd most common break and the most commonly broken facial bone. As in Paula’s case, blunt trauma is the most common cause (85% of cases) but the management is by no means straight-forward or easily agreed upon. One can be sure though, that if there was some significant damage, the physical exam portion was not comfortable for the former Laker Girl.
In case your interested, here are the indications for open and closed reduction of the nasal fracture from eMedicine (feel free to skip right by it):
Closed Reduction:
Unilateral or bilateral fracture of the nasal bones
Fracture of the nasal septal complex that is deviated less than one half of the width of the nasal bridge
Indications for open reduction are as follows:
Extensive fractures
Deviation of the nasal pyramid greater than one half of the width of the nasal bridge
Displaced fracture of the caudal septum
Open septal fracture
Persistent deformity after closed reduction
Ice packs and head elevation are the mainstay of treatment in the majority fo cases. If the reduction is not going to be done that day, then a period of 3-5 days precedes further evaluation. Fractures that are not displaced do not require treatment. Because as many as 30% of patients have a deviation that was present prior to injury, in many cases, obtaining photographs for review is helpful. God, woudl we love to see those pics - where’s TMZ.com when you need them?
2007-05-25
There are a few old adages that every doctor has heard a million times. Old clichés like Sutton’s Law (”Go where the money is”), “Don’t chase zebras,” and the Duck Prophecy, i..e. “If it walks like a duck, and sounds like a duck…” - you get the point.
As contrived as they sound, these worn-out tidbits are quite applicable on the floors of the hospital as it is easy to lose track of the forest through the trees. Comorbid illnesses, errant lab values, incomplete medical histories, and a slew of other variables can all contribute to making a relatively obvious diagnosis much less obvious.
So it is often helpful to keep those idioms in the back of one’s head as you ask yourself why an immunocompromised patient with chronic kidney failure, diabetes, congestive heart failure, a depressed white blood cell count and a crappy chest x-ray has 2 days of cough and low-grade fever. The differential for those symptoms could fill a book but the answer is most often the simplest (Hakim’s Razor).
It is this philosophy of sticking to the basics that enabled our staffers to correctly predict that Andrew Speaker would have his diagnosis reclassified, would not require surgery, and would make the federal authorities and a great number of my readers realize what an enormous overreaction this was to a truly benign incident.
Today, it was revealed that the Atlanta attorney who stirred up the ire of the non-TB-having American public has a less-severe form of the disease than originally diagnosed, according to his doctors.
We are not saying ‘we told you so’ to all of those adamant and aggressive StopPagingMe.com Huff Post readers that chastised us and berated us, but you know what? Chicken butt. Hah! We got you again.
Now Mr. Speaker will complete his course of medications, take off his mask, return to a normal life and have a positive PPD for at least the next 10 years or so.
“In the future I hope they realize the terribly chilling effect they can have when they come after someone and their family on a personal level,” Speaker said in a statement. “They can, in a few days, destroy an entire family’s reputation, ability to make a living and good name.”
