Thursday, March 29, 2007

Vickie Lynn & the Needle

Today we'll delve into what everyone else is yammering about: Anna Nicole Smith (39). Having plowed through her autopsy reports, at least this commentary will be substantive, ie, a firm basis in reality. And, we look at one of the more interesting drugs she was injecting along with a lot of other public figures: hGH.

The blogs were vicious about her while alive and only slightly less so once dead. She was said to have had a 100 lb. weight loss, body contouring surgery, and liposuction. They said she died of complications after yet another breast procedure. They said she had lupus. They said it was illegal drugs. They were all wrong.

So, just what did the 13 people crowded into that medical examiner's room find? She died accidentally after taking a cocktail of eight prescription drugs, all at therapeutic levels.

She was ill and in need of medical supervision, but her companions in the room noticed too late that the backwater Texas girl who pulled herself up from nothing by her bra straps was "nonresponsive and not breathing." You can hear fait accompli in the officer's voice on the taped call to the paramedics. She was DOA: it took them six minutes of pro forma at the hospital to pronounce her dead.

Officially the postmortem reads: "Accidental death due to acute combined drug toxicity due to ingestion of multiple prescription medications." Toxicology found sedatives (Robaxin & Topamax), anti-anxiety agents (Valium, Klonopin, Ativan, Serax), painkiller (acetaminophen), antibiotics (Cipro), antihistamine (benadryl), atropine, and the metabolites of diazepam (Valium). And they found chloral hydrate, a schedule IV controlled substance marketed as the sleeping aid Noctec. What did her in was the synergistic effect of the chloral hydrate interacting with the other prescription drugs: 7 + 1 = 20. In short, it's called the potentiation effect: right drugs, right doses, wrong combination.

What was she doing? There was no trace of methodone or opiates for the previous few days. Instead, her psychiatrist "friend" had given her a dirty injection of most likely B12 while in the Bahamas. The resulting abscess in her buttock spilled bacteria into her blood stream during the flight and she deboarded one sick puppy: 105 fever, chills, and prostration. Her psychiatrist pal is also the one who gave her the broad spectrum antibiotic (Cipro), OTC painkiller, and the chloral hydrate. The sedatives and anti-anxiety agents were part of her usual arsenal taken in various combinations over the three-and-a-half days she suffered, disoriented and improperly cared for. The atropine was administered by the paramedics as part of the futile attempt to restart her heart and respiration.

What else did they find?

There was extensive scarring of the soft tissues in the buttocks and the right anterior thigh. The latter is exactly what you would expect to find in someone who had been self-injecting hGH since 1999. Like insulin, human growth hormone needs to be injected subcu, because the molecule is too large to be absorbed orally. The coroner misstated that hGH is used for weight reduction. (Actually, the on-label use, sanctioned by the FDA, is to counter muscle wasting in AIDS patients.)

Produced by the pituitary gland, natural hGH levels begin to drop by age 25-30, significantly by age 40. An hGH "deficiency" in adults has exactly the same symptoms as aging. Physicians promoting anti-aging or youthful-aging programs use bioengineered hGH (somatotropin) and other bioidentical HRTs as the centerpiece of their treatment protocol. Human growth hormone increases muscle mass, decreases body fat, improves aerobic capacity, stimulates the immune system, elevates mood, increases bone density and skin thickness, lowers LDL, and ups the libido. Dose-dependent side effects (joint pain and carpal tunnel syndrome associated with fluid retention, insulin resistance) are easily reversed. What's not to love?

Bioidentical hGH has been used illicitly by athletes ever since recombinant DNA technique made it widely available. The 1996 Atlanta Olympics were dubbed the "hGH Games;" no blood test is available. The hormone can only be indirectly measured by it's metabolite IGF-1, already present in healthy young athletes. And it's not just for Olympians anymore! Pitcher Jason Grimsley told IRS agents last year that "boatloads" of big league players use hGH: Jason Giambi, Barry Bonds, David Sequi, Gary Matthews Jr, John Rocker, just to name a few.

Sylvester Stallone's (60) recent bust by Australian custom agents underscores the widespread usage by body builders as well. The last two winners of the Arnold Classic, Victor Martinez and Ronnie Coleman, are both associated with accusations of hGH use. It's not a steroid; steroid molecules have a basic chemical structure consisting of four interconnected carbon rings. But it is a hormone, available by prescription only. In the USA, any physician can write a script for off-label use and the pharmacist can legally fill it. However, in Australia that's not the case. As Stallone found out:
" have not been validly prescribed the goods by any medical practitioner for any medical condition suffered by you, and for which the goods are recognized medical treatment."
Note the Boolian logic of how that Australian law is constructed. If Stallone had been searched by US customs, he would have made it through since no US law would have been broken. That said, look at Stallone's neck. He's got the engorged look of injected testosterone.

Hear Anne live on the Kevyn Burger show 11:00 to noon every Thursday featuring Knifestyles of the Rich & Famous.

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