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Today Michael Jackson’s nurse practitioner and nutritionist — she is licensed in both fields — Cherilynn Lee, told reporters that five days before his death, Michael Jackson begged her to order a drug that is ONLY for use in hospitals for anesthesia — where patients are intubated to keep their airway open and on a ventilator that breathes for them — or in intensive care — ditto on the intubation and ventilator. (Nurse practitioners are allowed to prescribe drugs.)
The generic name of the drug Jackson sought is propofol and its brand name is Diprivan. It is given intravenously and burns, so the local anesthetic Lidocaine is usually given with it. (I assume the Lidocaine is either given as a topical spray to numb the IV site, or as a sub-cutaneous or intramuscular injection near the IV site.) Lidocaine was found near Jackson’s body when his breathing stopped.
While propofol could have stopped Jackson’s breathing and killed him because those are two of its side effects, the secondary cause of his death has to be his undiagnosed and untreated sleep disorders — at the least, he had insomnia. Yet I’ve heard nothing about Jackson being referred to a sleep specialist for evaluation, diagnosis and treatment. If he couldn’t sleep, he had a sleep disorder. He went to other specialists for particular problems. But for a sleep problem, Jackson was not referred to a sleep specialist and did not consult with one on his own.
Dr. Sanjay Gupta blathered on CNN about how he’d consulted anesthesiologists to get them to explain to him the use of propofol. Yet Dr. Gupta said nothing about how Jackson was desperately seeking medical help for a sleep problem AND YET NO ONE SENT HIM TO A SLEEP SPECIALIST. The thought that Jackson should have been under the care of a sleep specialist was not a cloud on Dr. Gupta’s horizon.
Instead, because Jackson has had so many surgeries and therefore had anesthesia so often — which put him to sleep — when he could not sleep he sought treatment with an anesthetic and an anesthesiologist. That is, he went after the drug and medical specialty he associated with SLEEP. He was not trying to get high. He just wanted to sleep, according to the statement of Ms. Lee, who strikes me as ethical and on-the-ball. But she only knew enough to refuse to order propofol for Jackson, or find him an anesthesiologist. But she did NOT know enough to round up a sleep specialist for Jackson and get a sleep study done on him stat.
Let me say this again. Jackson clearly had a sleep disorder that was tormenting him out of his mind — as sleep disorders do. YET NO ONE INSISTED HE CONSULT A SLEEP SPECIALIST — the doctor who has the expertise that could have helped him get the good night’s sleep he craved.
Really, gentle readers, sometimes I think it’s like the journals that print sleep research are published with ink and pixels visible only to other sleep researchers.
Here are a few of the specialties that should know enough about sleep research to refer patients to a sleep specialist:
Cardiologist: because sleep disorders can cause atrial fibrillation, intractable high blood pressure and idiopathic congestive heart failure. The cardiologist can treat those conditions, but will have greater success when the underlying sleep disorder causing all the trouble is treated, too.
Endocrinologist: because half of people who have hypothyroidism have obstructive sleep apnea, too, but blame their fatigue on the titration of their thyroid dose or the thyroid hormones prescribed. Also because endocrinologists treate people with diabetes — the sleep disorder frequently precedes the weight gain.
Psychiatrist: because they diagnose depression without ruling out hypothyroidism and obstructive sleep apnea and bipolar disorder without ruling out restless leg syndrome.
Neurologist: because people with multiple sclerosis very often have insomnia. (Note to regular gentle readers: my late life partner, Margaret, had MS and insomnia and for our first few years together felt so delicate about her sleep that we slept in separate bedrooms. Then an abusive member of her family visited and I gave up my room and had to sleep in the same room with Margaret. She felt so safe and slept so well that she insisted we sleep in the same room after that. So we did. She never had insomnia again.)
Rheumatologist: OK, on this one the only research I know about is that alpha waves during deep sleep are associated with fibromyalgia. Plus, my personal experience that I had agonizing joint and muscle pain that almost completely vanished after I began CPAP therapy.
Oh, and family practioners and internists should be referring people to sleep doctors, too, when patients complain of poor sleep or daytime sleepiness.
Whatcha wanna bet that NONE of the cable news channels or major networks or major newspapers or blogs have the slightest glimmer of awareness that Jackson is dead because he had a SLEEP disorder and did not seek care from a SLEEP SPECIALIST. And yet I expect they will go over again and again that he had sleep problems.
Make the connection, people! Make the connection!