Thursday, August 26, 2010

Michael Jackson Did Not Administer Propofol to Himself--A Medical Perspective

Michael Jackson Did Not Administer Propofol to Himself--A Medical Perspective

Introduction:
A few months ago I caught wind that Conrad Murray's defense strategy was going to put the blame on none other than the victim--Michael Jackson--in a way I never thought possible--by saying Jackson delivered the fatal dose of propofol to himself during Murray's supposed 120-second absence from the room. For Murray to imply this chain of events is a gross disrespect for the victim he claims was a "friend". I thought initially this defense was a bogus tabloid report, after all, Jackson's death was ruled by experts to be "homicide via injection from another". Thus, this defense strategy goes against the entire ruling of death by experts who I hope will testify and back up their (what I believe to be correct) conclusion--if there is a trial.

Before this hideous accusation of self-injection by Jackson, Murray had been trying to shift blame on Jackson all along through other methods, such as claiming he demanded propofol from him, essentially forcing him to do it. Murray did and still does possess free will. The exact wording of the Las Vegas search warrant states, "Jackson remained awake and at approximately 1040 hours Murray finally administered 25 mg of propofol diluted with lidocaine, via IV drip to keep Jackson sedated, after repeated demands/requests from Jackson." First, there was no IV drip delivering propofol as there was no manual/electronic pump to do so. The only drip used was a gravity-fed saline drip per the autopsy report. Second, you do not dilute propofol with lidocaine. Third, how is someone who is being kept sedated in fact wide awake and making repeated demands and/or requests? I pray the police and DA are carefully examining every word and every shred of evidence presented to them. I do not know if they are or not, but I believe if they were examining the evidence closer, the charges presented would be much higher than involuntary manslaughter.

Murray's false claim that Jackson self-injected, which will be examined in detail shortly, even if true still avoids providing plausible explanations for such issues as: the massive lapse in time (approximately 90 minutes) that Murray allowed to pass without rendering sufficient aid, lacking proper devices to render aid (the Ambu-bag was apparently part of the paramedics' paraphernalia as if Jackson was not breathing but had a pulse then Murray should have used the Ambu-bag with oxygen rather than performing mouth-to-mouth CPR; the autopsy report states the Ambu-bag was not even connected to the oxygen tank that was reported empty on 07/13/2009, rendering this life-saving object useless and likely unused), why Murray was seen toting oxygen tanks which without sufficient equipment were insufficient to treat apnea from propofol administration, why he performed CPR in a bed, why he did not get Jackson to the hospital when he was merely 4 minutes away, why he did not call 911 upon discovering Jackson yet had been using a cell phone that morning, why Jackson did not recover from the apnea when most people recover in less than 3 minutes, why there were "multiple opened bottles of propofol found, with small amounts of remaining drug", etc.? These are all questions desperately needing answers.

Murray also withheld information from paramedics, UCLA staff, and for two days, police. Admitting to only administering Ativan and saline prevented health care staff from determining what they were really treating. Treatment for propofol intoxication would likely have only been supportive/symptomatic but Murray should have been honest about what he had been administering Jackson, especially if some sort of accident (and should have administered appropriate supportive/symptomatic care to Jackson himself). Why lie, then, and how does a patient get denied such elementary care when a doctor is present and getting paid $150,000 a month to make sure the patient remains alive? How does one fail a patient like Murray failed Jackson when he has been a physician for 20 years? Murray deliberately, for whatever reasons, made no attempt to revive or save Jackson's life regardless of whom or what administered the medications based on information we know. In addition, by him refusing to declare Jackson deceased at the residence he delayed making the residence a crime scene which has without a doubt compromised this case and allowed room for corruption (see http://law.justia.com/california/codes/gov/27490-27512.html).

Discussion Regarding TMZ Live's Video Aired on 04/05/2010 Which Discusses the "Suicide Theory":
Please view the following video: http://www.tmz.com/videos?autoplay=true&mediaKey=54706d3d-e4e4-4f6a-b092-a55d8875de4a

Experts' Analysis Against Self-Administration:
From the autopsy report on page 11, in regard to the support of homicide, statement number four states, "(t)he circumstances do not support self administration of propofol."--Dr. Christopher Rogers and Dr. Lakshmanan Sathyavagiswaran

From Dr. Selma Calmes' report contained within the autopsy report:

"Could the decedent have given propofol to himself? It is unknown where the propofol physically came from. It would have been difficult for the patient to administer the drugs (others besides propofol were administered) to himself, given the configuration of the IV set-up. The IV catheter was in the left leg. The injection port of the IV tubing was 13.5 cm from the tip in the catheter. He would have had to bend his knee sharply or sit up to reach the injection port and push the syringe barrel, an awkward situation, especially if sleep was the goal. If only bolus injections via a syringe were used, sleep would not have been maintained, due to the short action of propofol. Someone with medical knowledge or experience would have started the IV. Anyone could have drawn up and administered the medications after the IV was started."

Please keep in mind that anyone could administer the drug but the IV configuration limited if not completely barred Jackson from being capable of giving it to himself nor was he skilled at IV injections. Also, the autopsy report says, "(l)ividity was consistent with a supine position" meaning when he expired and as fluids settled it was consistent with him lying down on his back. Dr. Calmes said he would either have to have bent his knee sharply or sat up in order to inject himself--his knee was not bent nor does lividity in the supine position support him expiring while sitting up and being left in this position. Murray could have placed his body in the supine position before lividity set in, but if this were the case, would that not mean Murray likely was in Jackson's presence during a time in which he should have saved his life and failed to do so? It could also mean Jackson remained in the supine position throughout Murray's medical "care" that night, further supporting that Murray was the only one to administered drugs to Jackson.

Syringe Size Debacle:
Perhaps one of the most pivotal errors in this defense is the claim that Jackson injected himself with the remaining contents of a 20 mL bottle of propofol. Only 10 mL syringes were available and used. This means Jackson could only inject 100 mg (10 mL) in one inoculation because of the very rapid onset of action of propofol. This dose should have in fact rendered him unconscious, unable to subsequently inject the remaining 75 mg (7.5 mL) until the preceding dose of propofol had worn off. He would have then had to have awaken to have injected the remaining 75 mg, representing another bout of unconsciousness only as long as 75 mg would keep him unconscious. It is impossible that Jackson gave himself 175 mg of propofol at one time based on medical supplies available. If Jackson was given more than 100 mg at one time then someone else had to do it to him as an unconscious man cannot manually administered drugs to himself.

What is a "Massive Overdose" and how Likely is Suicide/Accidental Overdose with Propofol?
Harvey Levin states that the bottle (a 20 mL bottle) was a "massive overdose". This is far from being true. Death from excessive propofol abuse by Iwersen-Bergmann, et al. states, " (t)he risk of death due to a self-administered propofol intoxication is very low, primarily due to the low concentration found in commercial ampoules (20 mL containing 200 mg). This is equivalent to a standard dose of 2-2.5 mg/kg body weight for the induction of general anesthesia within 1-2 min after injection and arousal after 5-10 minutes. The fast-acting narcotic effect of propofol prevents the self-injection of more than one ampoule at one time." Thus, 200 mg would almost certainly not result in death due to an overdose, especially not in a healthy adult patient like Jackson even if he was thin. The only way this may have presented a problem is if the benzodiazepines in Jackson's system were in fact sedating him and causing some respiratory depression. This would also mean Jackson was in fact unconscious. As mentioned in the previous paragraph, Jackson could not have administered the entire ampoule himself due to the small size of the syringes and subsequent loss of consciousness after receiving 100 mg (10 mL), the maximum amount one syringe could hold assuming no lidocaine was added. Sedation can be achieved from doses of 100 mg and less. In fact, 25 mg and 50 mg are typical bolus doses for induction of sedation according to Lexicomp and can cause sedation, albeit for a matter of minutes, if subsequent sedation is not continued with propofol or another substance.

The only way 200 mg theoretically kills a typical adult is to give it too rapidly (and to subsequently not have anyone there to render aid)--this itself is a rare event as death from propofol is infrequent even from people who abuse many times a day for months or in some rare cases years. Death from propofol almost always initially suspects third-party involvement, too, until proven otherwise. Death from Propofol: Accident, Murder or Suicide? by Kirby, et al. states, "Whether suicide is possible with propofol has been debated. Some investigators historically said no, because the maximum that was thought to be injectable, before the individual lost consciousness and was incapable of injecting more, was one vial (200 mg). This amount is equivalent to a standard anesthetic induction dose of 2.5 mg/kg to a healthy 80 kg individual." Jackson's weight was determined to be 136 lbs or 62 kgs. That means a standard dose for approximately 10 minutes of unconsciousness would have been 125-155 mg, slightly less than the supposed 175 mg self-administered (200 mg minus the 25 mg Murray admits to giving). Such a dose should not have been an overdose in Jackson. As discussed previously it is also impossible for Jackson to have over-rapidly injected propofol himself, too, based on IV configuration. The syringe size also limited Jackson to what amount he could have self-injected if able to defy the IV configuration. That leaves only Murray either lying about the amount he gave Jackson or possibly over-rapidly injecting him with a large amount of the drug and then failing to render appropriate aid while present.

Healthy patients who receive propofol for short-term procedures (ex. cardioversion, dental procedures, etc.) do not have to be intubated though propofol is almost always used with a patient intubated and having their breathing supported. Jackson, a healthy patient, had received propofol legitimately in the recent past by Dr. David Adams for dental work (http://www.lvrj.com/news/55332672.html) and no had problems. Cardiopulmonary equipment, such as an Ambu-bag and an oxygen with oxygen or a ventilator is on standby as a precaution any time propofol is given. Death after excess propofol abuse further states, "Hypotension and apnea are relevant side effects...and are probably dependent on dose and speed of propofol administration. Apnea during anesthesia induction occurs more frequently with propofol than with other anesthetics. The apena duration is usually short but it can persist for up to 3 minutes." Three minutes of cessation of breathing does not typically result in death, nor is this length of apnea common even from 200 mg. Furthermore, if Jackson had had his breathing assisted during the period of apnea with something like an Ambu-bag and oxygen, then there is no reason he should not have recovered fully. Jackson would still be alive today.

What about the Arm?
TMZ's video states Jackson had a "huge amount" in his arm. This has never been stated before nor have I found it stated anywhere else for that matter. This could all be a misunderstanding by the staff at TMZ given they do not have sufficient medical knowledge. Could Murray have administered this into his arm because the IV catheter tubing was no longer viable or desirable or the amount was too small to give via tubing? Jackson was essentially immobile with the IV catheter in his leg--was the propofol, syringes and needles within arm's reach to self-inject in the arm? Which arm had more propofol as Jackson being right-handed he would not inject into his right arm? Was Jackson even capable of injecting himself in the first place as he was not a trained medical professional? Was there any evidence of injection of propofol into his arm such as skin-popping? If in fact he had a higher concentration of propofol in his arm, could this indicate Jackson had limited-to no-circulation in his body (he was deceased or almost deceased) and the last dose essentially stalled within the circulatory system where administered, meaning Jackson was unconscious and it was given by Murray with Jackson in a grave state? I simply do not know what to make of this comment. I think it is better left for experts to examine or disregard.

Preparing the Syringe:
Another aspect of this case that bars Jackson from self-administering is the time frame he had in which to do it. It would indeed take many minutes, not seconds, to draw up and administer this medication, especially drawing the entire contents out of the glass bottle which wages a war with the syringe--it is difficult to get the medication into the syringe as it tries to continuously return to the bottle, even when air is misplaced for the liquid. Unless trained in giving IV drugs or preparing them it is a time-consuming task to draw up any large amount of contents from a glass bottle. Lack of training and experience often results in some loss of the drug when the syringe is removed from the bottle, too. In other words, using a syringe to pull medication from a glass bottle has a tendency to "spray" the contents out either from the bottle and/or syringe. Unless someone is highly trained or they have a vented needle these issues are almost inevitable. It does not appear that Murray had any vented supplies. Lidocaine was also found in the syringe, too, and would have needed to have been withdrawn from its glass bottling as well. I do not believe Jackson, within two minutes or less, could draw out propofol and /or lidocaine from glass bottling after just arousing from being sedated, self-injecting, then being in such a severe state that when Murray came back that he was not able to be revived. To further hint that Jackson was able to prepare not one but two syringes containing propofol and lidocaine, self-inject against all likelihood, and then be in such a shape he was not revivable--all in less than two minutes--is impossible.

Other Fallacies:
The mentioning of 10:00 p.m. in the TMZ video is false. Jackson was at rehearsals well past midnight that night per many witnesses. Furthermore, it makes no sense that Jackson was able to sleep on Ativan and Versed the night before (June 23rd) then suddenly on June 24th-25th Ativan, Versed and Valium could not induce sleep or apparently even drowsiness (though again Murray said he was "keeping him sedated"). An examination of Table 3A is not consistent with abuse or addiction to benzodiazepines, either. There is also an issue with Murray administering parenteral (through the skin) benzodiazepines when he had readily-available oral Valium and Ativan he could have given Jackson to try to induce sleep. A man who is sedated cannot swallow tablets, however. If Jackson really wanted to sleep, why not simply grab or ask for these tablets and take them in excess and wash them down with the water or orange juice on the bedside table? Why did Murray not continue giving Jackson benzodiazepines until he was sedated? If Jackson was overdosed on benzodiazepines, Murray could have remedied this with the flumazenil he had available.

This video mentions a drip of propofol again. There was no propofol drip. There was no manual/electronic pump. If the tubing used to administer propofol was 13.5 cm that is not long enough to hold up a glass bottle for a gravity drip, either. Furthermore, you would need vented tubing (which has never been said to have been found) for fluid to actually flow from the bottle. There was likely no vented tubing available based on evidence found at the scene. Given the finding of syringes with propofol and lidocaine, this seems to be the method Murray used to administer propofol to Jackson--via bolus injections which would place Murray there witnessing Jackson's response to the medications.

No reports have ever said that Murray was giving propofol for 60 days (eight weeks). Some say six weeks, some say two weeks. Thus far only one receipt has been discussed in the California search warrant. A receipt from 05/12/2009 shows what was purchased by Murray himself through Applied Pharmacy Services in Las Vegas. Multiple bottles of propofol, two vials of midazolam, one vial of flumazenil and one container of lidocaine cream were purchased. This receipt does not completely correlate with what was said to have been found at the residence so where did the remaining supplies come from and when? How many bottles of propofol did Murray buy during his duration of "care" of Jackson? One must understand a 20 mL vial only gives approximately 10-15 minutes of sedation if given via bolus (syringe). A 1000 mg bottles would give approximately an 60-90 minutes of sedation if given via boluses. If Murray was using propofol regularly on Jackson, whether one week or six weeks, then he would have needed numerous bottles of propofol, not just 5 or so bottles, regardless of size. Further examining the California search warrant also seriously questions the doses Murray claims to have given Jackson the day he died. Many vials, including vials of propofol, midazolam, lidocaine and lorazepam were empty. Empty vials do not correlate with Murray's small amounts stated as being administered on 06/25/2009. Either Murray was a vial hoarder, he wasted the medications to stage repetitive use of the drugs or he is lying about how much he administered of various medications to Jackson. Hair samples from Jackson could clarify this discrepancy in better detail.

"Dr. Murray's Defense--Jackson Killed Himself"
Please read the following link: http://www.tmz.com/2010/04/05/Jackson-jackson-dr-conrad-murray-propofol-death-cause-iv-addict-overdose-heart-legal-defense/59/#c3365156

Synergism Denied:
First off, the likelihood of the administration of three benzodiazepines failing to sedate Jackson is slim if not impossible. However, if they were not sedating him as Murray claims then a synergistic effect would be null as propofol would not suddenly cause the benzodiazepines to sedate Jackson--they either would or would not sedate him and propofol would take an effect independently. Propofol decreases the clearance of midazolam by inhibiting CYP3A4: An in vivo and in vitro study by Hamaoka, et al. states that midazolam (Versed) may be cleared at a slower rate when given with propofol but propofol's clearance is not affected. Propofol inhibits midazolam from being metabolized from possible competition of CYP3A4. This mean that if the midazolam had in fact been sedating Jackson the effects would have been prolonged but propofol's duration of action would not be effected. But, Murray claims Jackson was not sedated. Thus, once the propofol wore off within minutes as it normally would then Jackson would have awoke again as the benzodiazepines are said to have had no initial effect. If Murray is lying and Jackson was sedated, whether fully or partially on midazolam, then the midazolam had a longer duration of action than one would expect (the half-life of midazolam is prolonged by approximately 61%).

Insinuating Jackson was out an hour on 25 mg of propofol in conjunction with non-sedating doses of Ativan and Versed (which also wears off fast) is impossible. Plus, this does not match with the story Murray told detectives that is contained in the search warrant. Murray said he gave 25 mg, observed Jackson for 10 minutes then left no more than two minutes to use the restroom. I do not believe 25 mg of propofol is capable of keeping someone out for 10 minutes. If not previously sedated, which Murray claims he was not, then he would have woke up while Murray was monitoring him, before he went to the restroom.

(Lack of) Addiction vs. (Unintentional) Abuse:
Addiction to propofol is something I hope to speak about heavily in the near future. For a short synopsis, please read this blog, "Was Jackson an addict?". Please understand, one statement that remains consistent across the board is Jackson wanted to use propofol "to sleep". He did not wish to use it for a "high" or euphoria as if this was the reason for use then it would have been used in short bursts and Jackson would not have desired to use it under a doctor's care for the duration of the night with the anticipation of simply waking up in the morning to start the day after getting a much desired snooze. I cannot deny that using propofol for sleep is a form of abuse. That makes Jackson's case unique in that he was not abusing it for reasons of arrogance. Insomnia and fatigue can be catastrophic and even fatal and there is no doubt Jackson did in fact suffer from insomnia for years. Abuse and addiction are not the same thing. Jackson's reported request for propofol is a form of abuse that a lay person could naturally assume as reasonable as Jackson, I promise you is not the first, not the last or the only person to ever ask for propofol for sleep because they were fatigued or unable to sleep. Jackson, as a lay person, did not understand this drug did not render him true sleep, that it put him at grave risk for infection and apnea nor did he understand how it was administered or used given when it was administered he was unconscious. It was the duty of medical professionals to deny him of his what he likely assumed to be a harmless request in which he could not seriously consider the possibility of fatal consequences.

Enjoying Liquid Fire?
For TMZ to insinuate that Jackson "liked the sensation of propofol being administer by IV, adding, "Jackson liked to push it."--they should be sued for libel. Though not everyone experiences a burn with propofol it seems likely Jackson did given IV lidocaine was used. Many describe the administration of propofol as the most painful experience of their life. Propofol is only given by IV (peripheral, PICC or central line, etc.) and saying he liked to push it, well, that is a difficult task considering those receiving propofol become unconscious many times within seconds of administration. If Jackson wanted to abuse the propofol himself or thought that what he was doing was in fact abuse he would not have had Conrad Murray there to administer it and monitor him. Jackson did not think he was abusing propofol, he thought a physician was treating his insomnia.

The Fallen Bottle:
Below are photos of the crime scene/bedroom for discussion about the bottle found under the night stand:
http://www.intmensorg.info/images/mjdb.jpg

http://www.thesun.co.uk/sol/homepage/news/2573786/Pictures-of-Jacksons-death-mansion.html

This particular bottle of propofol was the only bottle found during the initial exam of the residence on 06/25/2009. It was found on the floor under a night stand in the bedroom (see Table 3A of the autopsy report also for this information). This is reported to be the bottle Jackson used to self-inject according to Murray.

Medical supplies were on the gold table/trolley/night stand seen in the photographs. He was lying on the left side of the bed if you are visualizing this from the foot of the bed. He was in the supine position. If Jackson was self-injecting he would have the bottle in his left hand and the syringe in his right hand as he was right-handed. He then likely would have used two hands on the syringe to draw out the medication from the bottle, likely suspending the bottle in the air with the syringe. This is most easily done with two hands even for a man with large hands. After withdrawal, he likely would have left the bottle in the bed, to his left, as the syringe should have stayed in his right hand. He would subsequently have pushed the syringe with his right or both hands. Under no circumstances does it make sense he would he have injected and then dropped the bottle to his right on the floor. He had to have been using his right hand to push in the contents of the syringe. The bottle could only drop under the table if it was in his right hand but this hand had to have been utilized to push the contents of the syringe. This essentially rips Murray’s notion that the empty bottle under the table was dropped by a self-injecting Jackson. Plus, was the bottle on the rug or hard floor? If it had been tossed and hit the hard floor would it not have shattered?

If a bottle of propofol was on the floor to begin with, which is possible, then Jackson could not have retrieved it with an IV catheter in his leg. Anyone could have placed the bottle under the night stand--including Murray. Whose fingerprints are on the bottle? Fingerprints would not necessarily implicate anyone but could rule out individuals--especially Jackson if his fingerprints are lacking and if he accomplished self-administration against all odds. I am sure he did not take the time to apply gloves if he could even reach them. If Jackson's fingerprints are lacking and Murray's present then that should answer the question of who used the bottle. Have fingerprints been lifted from the evidence? Would such occur for a involuntary manslaughter case?

The Broken Syringe:
One of the two syringes collected was a broken syringe discovered on 06/25/2009. This broken syringe contained propofol and lidocaine only. This syringe was apparently not hidden in a closet like the remaining supplies (including multiple empty bottles of propofol) listed on Table 3A as collected on 06/29/2009. Was this syringe found in the bed, on the floor, on the night stand, etc.? If it was used to self-inject it should have either been in the bed or attached to the tubing that was subsequently hidden. Did this syringe even contain a needle or was a needle found used to withdrawal propofol? Were fingerprints lifted off the syringe? When did this syringe break? Was it broken by means of the plunger (the part you push and pull) separate from the barrel (what holds the contents)? If this is true, then this syringe would not have been useable. Jackson could not have used a broken syringe to have either drawn up or injected propofol. He certainly could not have broken it after losing consciousness either.

What does the tubing say about dosing?
I previously questioned the doses Murray claims to have administered to Jackson due to numerous empty vials found. Murray claims to have given only 25 mg (2.5 mL) of propofol to Jackson. The tubing used to administer propofol was said to be 13.5 cm long (approximately 5 inches long). Could 2.5 mL travel through the tubing to reach Jackson? That seems unlikely unless Murray flushed the line. Supplies to flush the line were apparently lacking and he did not flush the tube before disconnecting it. The tubing contained 0.47 g of liquid containing propofol, lidocaine and flumazenil. If Jackson was given only 2.5 mL of propofol then it seems this would have to have been given directly through a vein, not the tubing as it would not have reached the blood stream. If the tubing was used it seems that Murray had to have given more than 2.5 mL. Regardless of which scenario this points to Murray again lying about how much propofol he gave Jackson that morning.

Clean Up Before They Come:
Murray’s lawyer maintains that Murray did not do a "clean up" before paramedics arrived. Really?
http://www.tmz.com/2010/03/22/conrad-murray-Jackson-jackson-propofol-cpr-drug-vials

http://www.tmz.com/2010/03/22/witness-dr-conrad-murry-hid-propofol-Jackson-jackson-death-police-closet

http://www.silive.com/news/index.ssf/2010/03/unsealed_search_warrants_revea.html

In the autopsy report, an empty glass vial of propofol, an empty glass vial of flumazenil, and the broken syringe with only propofol and flumazenil are mentioned being found on 06/25/2009. These items were not hidden.
Multiple bottles of propofol (some of which were used), another syringe containing flumazenil, propofol, and lidocaine as well as IV tubing also containing these three medications were found on 06/29/2009 in a closet (http://www.radaronline.com/photos/image/15324). Also found in a closet on 06/29/2009 were a blood pressure cuff and pulse-ox--two items that should have been at the bedside the entire time and caused no suspicion, whether giving propofol or not. These two items, if used, would have helped keep Jackson alive. These items were likely not used, for if they had been used Jackson not only would likely be alive but they would have alerted Murray of possible trouble and then later confirmed that Jackson was deceased. All the mentioned items above were indeed hidden, indicating a "clean up".

It has been stated that Alberto Alvarez was asked by Murray to remove the IV tubing that contained "a white liquid", that being propofol. Did paramedics take notice of the propofol bottle and/or flumazenil bottle later found by detectives on 06/25/2009? Were these left accidentally on purpose in an attempt to stage a scene? Possible alteration of the crime scene to make it look like a suicide is highly possible given Murray's defense. This, in turn, could indicate pre-mediated murder if enough forethought was given to stage the scene in such a manner. Murray's claim that he needed to go back to retrieve petty skin creams (and having Jackson taken to the hospital instead of being declared dead at the residence) also indicate he wanted to go back to either alter the scene further or remove some items from the scene. Why did Murray take the time to hide evidence while insisting Jackson was alive and implied he could be saved? Why would anyone who is responsible for keeping someone alive take the time to hide evidence rather than render or seek aid continuously? Why are Murray and his defense team lying about a "clean up" when one is clearly evident?

Has anyone asked Murray what he did with the syringe when he gave the supposed 25 mg? If Murray's syringe had been moved from where he had left it prior to his restroom break, it would have been apparent immediately to Murray because the propofol bottle, syringe, etc. would all have been moved and placed in such a matter supporting self-injection. Why not leave the area as-is if it were an accident done by the victim himself? Murray should have left everything in place as time was of the essence and Jackson's life, according to Murray, was hanging in the balance though reports do not support him being deceased. Why essentially tear down an scene that really is an accident?

All the aforementioned statements above raise the question of why did Murray tamper with the scene. If he genuinely did not know what happened in that room while he was out he should have left everything in exactly the same place as he found it and focused on saving Jackson which did not require the removal of items into closets and medical bags. There is no excuse for the delay in calling 911 or not having proper resuscitative equipment either as that is precisely why propofol is given in a hospital setting only. Murray should have informed paramedics of his suspicions, and been honest, instead of saying he had only given Ativan to Jackson. Murray has been anything but honest.

Conclusion:
There has also been some mention that a 100 mL (1000 mg) bottle was found in a closet with a large rip in it, indicating it was used for some sort of make-shift drip. I have debated whether or not this is true and lean towards it being false. If Murray did not have some form of vented tubing there would have been limited to no flow of liquid from the bottle as glass bottling must be vented to flow. If Murray by some chance had some vented supplies on hand and given it by gravity it would have killed Jackson. He apparently would have also had to have held the bottle attached to the 13.5 cm tubing which means he would have witnessed what was occurring to Jackson. If he did in fact use the 100 mL bottle that would also indicate he staged the scene with the 20 mL bottle left behind in the room.
Death after excessive propofol abuse states, "After a bolus injection, consciousness is lost in patients at propofol blood concentrations of 1.3-6.8 mcg/mL Consciousness was regained after 8-10 minutes at concentrations of 1-2.5 mcg/mL." The article further states that in their patient case (a male nurse who died from rapidly injecting multiple 200 mg doses over a period of at least 6 hours based on urine samples) likely died immediately after the final, rapid propofol injection due to his blood level being 5.3 mcg/mL--compared to 4.1and 2.6 mcg/mL in Jackson, respectively. Both these levels are consistent with Jackson not only being unconscious but would seem to indicate he, too, may have died shortly after injection. We also, however, still have to grapple with the information from the autopsy report that states multiple bottles of propofol were found empty. Keep in mind even though many bottles were empty, an enormous amount of propofol is needed to keep someone sedated for any length of time--200 mg (one 20 mL bottle) roughly gives 10 minutes of sedation. How many bottles did Murray buy while Jackson was under his care? How did Murray intend to keep this routine up or was he inducing sedation with propofol then using benzodiazepines to keep him sedated/asleep? How was Murray to receive propofol in London? Did he intend on giving propofol to Jackson in London? Was Jackson expected to live to see London?

Jackson's urinary propofol levels do not support him receiving propofol for any serious duration of the night on 06/25/2009 (less than 0.10 mcg/ml and 0.15 mcg/ml versus 5.4 mcg/mL in the male nurse who had been using the previous 6 hours before his death). How much did Murray really give Jackson that morning when Jackson should have been up and ready to begin his day? Murray being a medical professional and by admitting he had given propofol to Jackson before knew the possible consequences of giving this drug too rapidly and knew how much to give as well. He may have given bolus injections before on patients for cardioversions. He also knew it was not a legitimate regimen for insomnia, either, as it does not even induce true REM sleep and can be fatal if given without respiratory assistance. He knew how to do CPR, he knew Jackson was deceased at the house and he knows what really happened. So why are people like me and others having to try and piece this together when Murray knows the truth?

If Jackson could not have injected the contents and killed himself nor could he have completed this while Murray was out of the room then Murray's defense is null and void . Evidence certainly seems support this and likely if more evidence was known then this could likely be established without reasonable doubt. If that is then true that a much deeper analysis should be completed regarding Jackson's death as pre-mediated murder seems to be more likely than anything accidental.

Special thanks to "QuirkyDiana" for her contributions.

38 comments:

  1. Thank you Nikki for all your hard work in writing your blog, especially this post. It is not easy for a layman (or woman!!) to understand all the findings from the autopsy etc but you are helping me to understand so much. You manage to be objective whilst at the same time express your deep concern and outrage for the way Michael was treated.
    Please continue in your quest to see truth and justice for Michael.
    I will need to read this a few times as there is so much to take in.
    Thank you again....it's all for love.
    Junie XX

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  4. Hello nikki, i´m meigadas from twitter.
    What i wanted to explain on my tweet is before that MJ could inject such dose of propofol as 300-400mg himself he became asleep with the first 25-30 mg. This dose is enough to induce a low sedation, the patient seems to sleep, but the patient keeps the capacity to response to external factors as pain, and many verbal requirements, the patient also keeps breathing but CAN´T MAKE voluntary movements like take the sirynge and keep on injecting the rest of the dose. IMPOSSIBLE!!!!!To do so, he would need an infussion equipment. And there was not an infussion equipment...am i wrong???
    So, to MJ 25mg-30mg is enough to induce this level of sedation, and if we want to keep him on it we have to inject doses ( maybe the same dose in ten minutes) or use an infusor equipment. Programming the exact dose on this equipment depends on the patient´s adaptability, the weight, the duration of the surgery and of course the use of anothar drugs.
    The only benzo we use before propofol is midazolam, 1mg-2mg is enough to reduce anxiety before the surgery but we wait 15 minutes to begin the sedative induction; why? because midazolam+propofol= run to intubate...

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  5. Hello Meigadas!

    Thank you so much for the information!

    Yes, you are right, there was no infusion equipment. Only 10 mL syringes were available.

    So would 25-30 mg sedate about 10 minutes or less in a person like Michael? Is that type of sedation similar to a ventilator patient who is receiving a drip of propofol to help them keep from fighting the vent?

    Also, that sedation level, would it seems like "sleep" to Michael or would he just seem to be highly groggy? It seems he would want to be completely unconscious, as if it were true sleep.

    Yes! Midazolam and propofol actually have some issues--propofol is thought to decrease clearance of midazolam by 61%. Murray HAD to know this, not the 61% but that these two medicines together are dangerous. Propofol and midazolam have similar warnings on their packaging. So horrible to think Michael not only had propofol and midazolam given to him but also lorazepam and diazepam!! :-( Sounds like a lethal cocktail with only death imminent especially without any way to get oxygen into Michael's body via a ventilator or bag-valve mask.

    Thanks again!!

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  6. "So would 25-30 mg sedate about 10 minutes or less in a person like Michael? Is that type of sedation similar to a ventilator patient who is receiving a drip of propofol to help them keep from fighting the vent?"
    No, it´s not the same type. It´s a level that gives you a superficial sleep, you don´t need a ventilatory support ( you can breathe for yourself) BUT you need oxygen therapy on a low doses; and ALWAYS oxygen´s monitorization.
    "Also, that sedation level, would it seems like "sleep" to Michael or would he just seem to be highly groggy? It seems he would want to be completely unconscious, as if it were true sleep."

    Some patiens have described it like a superficial sleep with a dreaming sensation.
    Sometimes, the patient´s adaptability is not enough and you need to increase the dose; and sometimes when the patient has another drug prescription with benzos, and the patient usually need them to sleep, you have to increase the dose but not a high increase.

    Anyway, my experience as a nurse on Intensive Care Unit is diferrent as a anesthetist´s nurse.
    On a ICU it´s very common to care of intubated patients that need ventilatory support. In my unit we had this type of patients totally sedated with Propofol in a continuos infussion and a mixture of another drugs as opiod or derivatives. When a patient was well enough to breathe for his/herself; we "wake up" them. When you talk to this type of patients they don´t remember anything but their sleeping cycle was totally altered. Sometimes they could describes their sensations, sometimes they could tell you about nightmares. But experts say that this sleep is not a healthy sleep. It´s only a way to keep critics sedated to cure their status.
    So , in my opinion, propofol only could have given a "artificial" sleep to MJ, and only with the enough dose to keep him with a suportive ventilatory.
    Thanks Nikki.
    You´re an amazing writter and a great analyst

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  7. Thanks meigadas!

    I guess my last question would be--do you agree that there is no logic behind Murray giving 25 mg bolus to Michael for "sleep" that morning or anytime before? I mean, to have kept him "out", he'd have to give it on a very, very frequent basis. It seems this would almost be impossible to pull off, keeping him sedated by giving him boluses every few minutes, and we still cannot forget the benzos! That is why I am having some problems with his death--that is why I question motives so often. Not to mention, there were two 10 mL syringes that had been used, with propofol/lidocaine (one had traces of flumazenil, too) so him saying he gave only 25 mg is undoubtedly false. Either he gave more, or some third party did, not including Michael. Even that being said, Michael receiving it was wrong in so many ways. As someone put it back a few months ago, it is like asking for chemotherapy for a hair cut except chemotherapy really does cause hair loss--propofol does not induce true, natural sleep.

    Interesting about the sleep not being healthy. That is part of the reason why I have been questioning these rumors that Michael received propofol on the HIStory tour, along with other reasons. He needed real sleep for the tour, not an unhealthy or fake sleep or how could he pull off such a rigorous feat? I also cannot imagine a doctor keeping him out with propofol for 6-8 hours without the need to intubate at some point. Would that even be possible? Also, there is the possibility of infection, PIS, pancreatitis, etc. Just seems like something is wrong with the scenario.

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  8. Well Nikki, your welcome.Here we go:

    "I guess my last question would be--do you agree that there is no logic behind Murray giving 25 mg bolus to Michael for "sleep" that morning or anytime before?"

    There´s not logical, nor reasonable motive to think on that possibility. No way. It couldn´t give MJ a real sleep. By possing the posibility: after the propofol-sleep session MJ would have been refused this therapy for its efectiveness.

    "...there were two 10 mL syringes that had been used, with propofol/lidocaine (one had traces of flumazenil, too) so him saying he gave only 25 mg is undoubtedly false."

    Of course. It´s very important notice that with all the drugs you have to use differents syringes that gives you the right precision as you injected the dose. So, two 10 ml syringes gives you 200 mg , but if you mixture it with lidocaine to minimize the painfull effects that causes inside the vein, you have 180 mg of propofol. More than enough to induce a stop breathing in a man like MJ.

    " Also, there is the possibility of infection, PIS, pancreatitis, etc" and phlebitis, and this is the very first adversse effect that causes the injection of propofol, and very painful...

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  9. Thanks meigadas very, very much!

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  10. Wow Nikki!! You go gir!! I've never read such a detailed and well written blog post before about MJ's death from propofol!

    One of the co-admins of my blog is a nurse (I'm not sure of the exact title,but I think she's a psychiatric nurse). She's also very knowledgeable about medicines, and she's like the "medical correspondent" of my blog. I'm going to send her this post for her to read, because I'm sure she'll enjoy it, and I'll tell her to leave a comment.

    I'm also going to add your blog to our links! This is some good stuff!

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  11. thanks for this article, very interesting.

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  12. re-reading this as it's become news again that this will be the defense. many thanks for this...it makes sense even to people like me with no medical background whatsoever. so grateful for you voice during this time.

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  13. Truly excellent work here by the fantastic Nikki. I have been tweeting this link and will continue to do so throughout the trial.

    If anyone reading this has any, even tenuous, links to the prosecution or public figures who can help, then try to get the information here to them.

    Failing that, blog the information here on public sites -- sooner or later it will get picked up and discussed in the public domain.

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  14. Fantastic article! Thank you so much. But here is what is puzzling me. Even if somehow or another the patient was able to self administer (though this seems quite impossible), isn't it still the physicians responsibility to control where and how this dangerous medicine is stored? Isn't it negligent to leave a lethal dose of any medication within the reach of any patient, especially one you have just administered powerful sedatives to? Why is self administering even considered a possible defense? It's the physicians responsibility to control the medication and keep the patient safe, end of.

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  15. Thanks guys!

    Lisha--yes, if by some defiance of all obstacles a patient was to be able to self-inject, and the doctor had set it up to administer this drug in this fashion, it is the the doctor's responsibility because he should be there monitoring the patient and it was wrong on his part to have it set up in such a form! I mean, Jack Kevorkian, though I do not know a lot about him and I am by no means saying Michael wanted to commit suicide, but, Kevorkian did not actually kill his patients--he devised a manner for them to "humanely" kill themselves. That is my understanding, at least. The patient, not he, was responsible for actually initiating the death yet he is in prison and has been for years, charged with murder, and I honestly do not know when he will be released, if ever. Yet here Kevorkian was assisting terminally ill patients to die, patients in pain, agony, with no hope of being cured. Michael wanted to sleep--not die, yet Murray put Michael not only in a more dangerous position where Michael had no control of his situation but he also was treating Michael so inhumanely!!! It is just...SICK!

    I think Murray's attorneys are trying ANYTHING because they know that there is no excuse for anything Murray did and they are lucky to be facing involuntary manslaughter. So, who else to blame but the only other person in the room who also happens to be the victim? How low can one go? Michael is gone and Murray makes himself out to be a victim? He still has his life, sadly, when Michael is the one who lost his life senselessly! I am shocked Murray has not either said someone else snuck into the room and did it (though again, he is responsible, he set all that crap up, etc) OR claimed Michael wanted to assist him in suicide! We would know that is a lie thanks to people like Cherilyn Lee who said Michael was seeking propofol to help him sleep 8 hours a night so he could get through the tour. Not only that, but for all Michael went through, and survived, why give up when on route to seize the world again? Above all though, Michael would never abandon his children or his fans--never. They were his life and he knew his children depended on him and needed--he loved his children, and his fan, more than himself and lived for them, for us.

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  16. Dear Nikki,

    Thank you so much for the time and incredible effort you put forth in giving us this detailed and most insightful report about propofol and Murray's astonishingly negligent actions.

    No one could convince me that Michael would take his own life. Yes, he was probably suffering terribly from insomnia and the stress of facing a 50-concert gig. That, combined with decades of relentless media abuse most definitely took an enormous toll on his life. However, Michael loved his children (and his fans!) and would never deliberately abandon them. Given what we know so far, even the most disinterested person should be asking why the charge against Murray is not 2nd degree murder?

    In the weeks following his autopsy's release, I started to wonder what really happened. I knew his fans were among the most loyal and caring people in the world and there would be very knowledgeable people who wouldn't rest until they got to the bottom of what really happened. While I do believe that Murray is directly responsible for Michael's tragic death, many of us also wonder if there's more than what has been made public. Sadly, Forbes reported recently that he is now the richest "dead" entertainer. Many stood to gain more from his death.

    It's all so disturbing and heartbreaking. I understand the importance of doing all we can to make sure that the media reports the facts before, during and after the trial. It's most important to rebut the garbage by making it clearly understood that Michael is NOT on trial--Conrad Murray is.

    Poor Katherine. Can anyone imagine her heartache? I'm sure she recalls over and over again the day she first held him in her arms. She knew how special he was the moment she looked into his beautiful dark eyes and to see and endure, right along with him, the pain and mental torture, and ultimately have him taken from her so thoughtlessly and cruelly, well, my heart just aches for her. God! He has touched our lives so powerfully and probably a day doesn't go by that we don't think about him, listen to a song, or watch a video, and we just miss him so much. But, I just can't imagine how his loss has affected his family, especially his mother and his dear children. Fortunately for them, they are young and resilient. They benefitted from his loving parenting and they, along with his unmatched humanitarian efforts, will be his greatest legacy.

    God has blessed you with rare gifts, Nikki! How it must please Michael to see you use them so well and share them with the world.

    Thank you so much!

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  17. Thanks for the article.
    Justice must be done.

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  18. I know I am late to the party, but this is an AWESOME POST!!!!!
    I have been blasted by bloggers as of late for my rejection of the theory that MJ was addicted to propofol for many of the same reasons you stated here. Because the defense is gonna go the he was a druggie route. Because if he was in fact addicted to propofol, then he would probably self inject or drink it. The problem with this theory is in order to use the drug in the manner that MJ did it required the constant presence of a second party.
    MJ clearly knew what the drug was and had used it before, as he requested it. If he had an addiction to the drug one would expect that he would have had an doctor on call to administer it, and would not have had to ask the nurse or hire Murray. He asked nurse Lee to help him find someone to give him the drug. Addicts don't usually need help seeking out the drug of their choice.
    In my humble Layperson's opinion I think MJ was using propofol as a part of his regemine for tour prep. Do not pass go, do not collect 200 dollars go directly to propofol.
    I believe that he demanded propofol. I think he wanted that straight away. Why bother with the benzos when they don't always work. (He'd been given benzos in pill form for years so he probably had quite the tolerance for those drugs) He did not have time for that. But propofol because of his body's limited exposure to it worked every time.
    Another quick note on the addiction ruse, If he were addicted to something wouldn't it be more likey to be the benzos that he had regular access to. And they have been documented as being highly addictive. There were bottle of those benzos found in his bedroom with dates a month back that were barely used. Not the sign of somone who is in the throes of addiction.

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  19. Nikki, have you read this garbage? It's by an "entertainment lawyer" named James L. Walker. He wrote it in Sept. 2009, and boldly labels MJ a "drug addict". This is really ironic, considering that it's coming from a damn lawyer and NOT a doctor!

    http://articles.cnn.com/2009-09-02/entertainment/walker.jackson_1_dr-conrad-murray-drug-abuse-drug-problem?_s=PM:SHOWBIZ

    Here is his official website: http://www.walkerandassoc.com/v4/index.php?option=com_content&view=section&layout=blog&id=1&Itemid=77

    Don't get me wrong, he's not a MJ hater, as he is currently working on a book about MJ's business deals, and he admits to being a huge fan. http://www.walkerandassoc.com/v4/index.php?option=com_content&view=article&id=147:attorney-james-l-walker-jr-prepares-to-write-his-second-book-about-the-late-michael-jackson&catid=19:press-release&Itemid=77

    I wanted to give you his article so you can use it as an example of how misinformed people often times pigeonhole MJ as an "addict" without proper research! He didn't even mention the autopsy report, which had already been released by the time that article was written! We should definitely send him your articles!

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  20. @ Ebony
    You said the following: "I have been blasted by bloggers as of late for my rejection of the theory that MJ was addicted to propofol for many of the same reasons you stated here."

    I'm curious to know who blasted you, and what they said about you, so can you provide links to your blog (if you have one), or their blogs so we can see why they believe MJ was an addict? (Other than their own prejudices about him!)

    Thank you!

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  21. @ lcpledwards74
    This was not on my blog. I haven't started one yet. It was
    Trials and Tribulations-
    http://sprocket-trials.blogspot.com/2011/02/dr-conrad-murrays-death-drip-explained.html

    I think most of their claims were from personal prejudices and media crap and general ignorance. Most seemed to mean well, they were just tragically uninformed.

    I managed however after several attempts to get through to most of them and the meaner comments were deleted.

    There was no way I was going to let that go unchallenged. :)

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  22. Hey everyone! Wow, I have a lot of messages here to to respond to so let me start one at at time--

    LadyPurr, thank you so much for your beautiful words!

    "No one could convince me that Michael would take his own life. Yes, he was probably suffering terribly from insomnia and the stress of facing a 50-concert gig. That, combined with decades of relentless media abuse most definitely took an enormous toll on his life. However, Michael loved his children (and his fans!) and would never deliberately abandon them. Given what we know so far, even the most disinterested person should be asking why the charge against Murray is not 2nd degree murder?"

    I could not agree with you more--perfectly said!

    When I first heard news that Michael passed, I wasn't so sure he was killed intentionally because I am the kind of person that wants proof to slap me in the face a few times. When I first heard that it was propofol I just cried my eyes out--I knew that was it and it was just, shocking. How a doctor could ever consent to giving this for insomnia is beyond me--but, you know, I could see some evil person lying to their desperate patient, their supposed "friend" mind you, all for money.

    But, when details emerged about what was in the house and what was not, when I realized Murray apparently did not even bother to use the pulse-ox that was in a closet in another room, when I realized he had no means to give Michael sufficient oxygen, when I realized he failed to prepare not for possible disaster but disaster that was inevitable--that is when I thought okay, something is wrong here. You do not buy some bed pads and a condom catheter but not equipment to make sure your patients BREATHES and expect them to live. That is when I thought oh my God, I really believe Murray wanted Michael to die, how else can you explain the lack of not only not being prepared or monitoring, but lacking any means to keep your patient alive when, as a doctor, you know what not can but WILL happen to him giving not only propofol but lorazepam, too?

    I can't say why Murray did what he did, I cannot say when this was planned or thought out, I can only guess and I don't like to guess on anything--I hate being wrong and leading people in the wrong direction. But, I can almost say, without a doubt, that Murray created an environment in which Michael was to die rather than sleep--nothing present in that room was conducive to giving the man what he really wanted--a good night's rest, something so many take for granted.

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  23. Ale and Ebony, welcome!

    You know, you mentioned Michael taking benzos over the years. I figure he did, many people do. I am sure he was certainly on them during the 2005 trial and anyone in such a position would NEED them--how dare anyone try to insinuate him taking medications for anxiety during that as being abuse or addiction. They need to back off--they probably wouldn't be able to survive such an ordeal, meds or not.

    But, I was shocked to see almost every benzo, besides the diazepam dispensed only 5 days before he died, was written only for nightly use as needed. I was floored--this man had a stressful life--I figure hed would "eat" benzos, you know? But he didn't, he didn't at all from what we can tell. The more I look into things the more I think Michael didn't like to take medications and avoided them when possible, especially if he was to take them himself, like not finishing his antibiotics or taking his Flomax, or not taking/seeing any medications for chronic use for systemic lupus which I firmly believe he had (some with lupus take a drug called Plaquenil). He just doesn't appear to have been a fan of medications at all.

    I know some sources I have read say people who take benzos do not develop tolerance when taken for anxiety but will when used for insomnia. I disagree--I think tolerance and dependence can develop for both conditions and a lot depends on which benzo is being taken. A drug like Xanax can build tolerance very quickly because its effects are so short compared to say, Vailum (diazepam) which can last most of the day. When you take a benzo that slowly tapers off rather than works a couple hours then is done, your chances of tolerance or withdrawal when you go without it goes down. I know that benzos are not recommended to take for insomnia more than about 2 weeks or a month (many other insomnia drugs also are not recommended to take long-term, either). To me, treatments for insomnia have a long way to go before something is available that is safe to use AND works.

    Anyway, back on topic...

    You made some great points about addiction, or rather, the lack there of with Michael. Also to add to this, back in 2007 the Cascios saw nothing (though now, thanks to so many lies, are assuming he hid some addiction from them though they saw nothing, no impairment, no drugs, no paraphernalia which means duh, he was not on anything). Nurse Cherilyn Lee saw nothing when she was treating him in January and February--she did not see him in March--and it wasn't until April he mentioned his insomnia was now problematic (he had causally mentioned it before but did not ask for any treatment for it) and asked her only then about propofol.

    With a drug like propofol, people who abuse it, they self-inject and at times can inject up to 100 times a day because the drug is so short-acting that it must be almost continuously given (if unconsciousness is what they are seeking, which is usually the case) because a dose of 200 mg is usually only good for abotu 10-15 minutes of unconsciousness.

    I hope people realize propofol that is drank would do nothing--and when people insinuate this they are insulting Michael's intelligence--he knew for it to "make him sleep" it had to be given IV or he'd ordered it himself and not asked for a doctor to not only administer it but also to watch him and make sure he was "safe". (Continued...)

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  24. Yes, if he had an addiction to this drug he'd needed someone there giving all the time--he was, by many accounts, never the kind that would have self-injected himself (though I know idiots like Boteach Schmuley say he did though he never witnessed anything and Michael had no skin markings consistent with chronic IV drug abuse)--he was needle-phobic. But, that whole notion can be tossed, the drug does not cause withdrawals or tolerance so if you don't have tolerance or withdrawal then you will not experience the effects of physical addiction! Murray's BS of "weaning" is just that--BS. The drug is not IDed as a drug of "abuse and/or addiction" by the DEA (however benzos are thus regulation is much tighter on them). Yes, there are cases of people abusing propofol but there are also cases of people abusing bath salts which appears to be the new craze. People abuse White Out, they abuse aerosols, carburetor fluid. Seriously, it goes to heights no one would imagine--that is real "addiction". Anything can be psychologically addictive, even food is, sadly for many--a psychological addiction is more of a mental issue rather than physical issue with the drug or substance. Michael may have thought propofol was the only medication to help him "sleep", he had tried other methods, legit methods Lee had provided to him but they did not work, but this bit of Murray "weaning" is only indicative of physical symptoms of addiction which do not exist with propofol. I know there are going to be some people, including medical professionals like doctors and what not, say that it is addictive. But, ask a nurse who gives it for years and see what they say--they will tell you it is not addictive. It is not like morphine, it is not like alcohol. Michael was not addicted to propofol and he was not being weaned.

    There is a quote I have posted before from an article I have access to that I need to find and post on here. I think I have posted it somewhere on this blog but not sure. (Looking...)

    Here is part of the quote, from here:

    http://gatorgirl277.blogspot.com/2010/06/propofol-death-cases-quick-historical.html

    "An article by Kranioti says, "Propofol lacks affinity to opiates, benzodiazepines or NDMA receptors and hence does not a have the potential for abuse or addiction than is always associated with the risk of overdose, as in the case of fentanyl or ketamine. Most abusers do not develop a true dependency to propofol since there is no evidence of tolerance, which refers to the need to increase the amount of drug to maintain a given response."

    But, there is more to this quote I need to add which makes it all flow. I will post it up here shortly.

    If I recall correctly, this article was written in about 2006, so it is not old or outdated, either. The quote I want to add discusses why some patients who use this medication may see a need for an increase in the dose (not sure if that is from the same author or not) and it also describes the author's theory about psychological addiction which is basically the same thing I said above.

    Do I think Michael asked for propofol? Yes I do. Do I think he thought he would be okay while using it? Yes, I do. Could he have been okay? Perhaps, if he was actually monitored and necessary equipment was on hand and ready for use. I am not sold on him having it for like, 8 hours a night while on tours before because I have yet to understand how he could have been given adequate oxygen without being intubated and I do not believe a doctor would intubated a patient nightly, especially not a singer and a singer on tour at that. Thing is, when Michael was sleeping, and if he was getting medications IV, then he had no real clue what he was getting while sedated. It could be he was given it just to initiate what he thought was sleep but then it was maintained with something else that does not cause apnea/stop breathing.

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  25. The Sprocket blog--I am so glad you have gone there and tried to reason with them. I have not had time yet to read the entire blogs they have posted but I will say I am not pleased as I have been notified of things that are simply not true on the blog, like saying hydrocodone was found in the house--no it was not. There are other issues, too. I won't say much else because I am actually going to write a blog addressing all of the problems I see rather then trying to go comment on there and having my posts either deleted or ignored. I agree with you totally that it is just ignorance, either at knowledge or moreover from not knowing the full scope of information from Lee, from the autopsy report, from the very beginning.

    Speaking of that blog, I still believe that Murray did not utilize a makeshift drip, I still maintain he used the syringes to administer the drug. I will investigate this further though very soon!

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  26. David, I remember that fool from way back when. I thought he had fallen off the face of the Earth--thing is--why would anyone take the word of an attorney (an entertainment one at that) when it comes to discussing medical information? That is like asking a doctor about the penal code and expecting a qualified answer. Is there a way to send him my blog or something?

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  27. @ Nikki
    Even though that lawyer is an idiot who isn't qualified to diagnose MJ as an addict, I don't think he had any malice in his heart, and he's a fan who respects MJ. I think the overall tone of the article was that we as a society need to do something with the epidemic of addiction in our country, and unfortunately he used MJ as an example.

    It's no different than what JVM did in her new book, except for the fact that I believe she DID have malicious intent (otherwise, she wouldn't have called him a "pill popper"). Combine that with her "friendships" with Dimond, Grace, Bloom, etc., and her history of biased reporting, and it all adds up!

    Here is his contact info if you want to send him a link to some of your articles. Personally, I think we have bigger fish to fry, and because I don't think he had malice, I think we should just "let it slide" LOL!

    Now, if he writes another article like this during the trial, then yes, we should bombard him with links to this blog and others!
    http://www.walkerandassoc.com/v4/index.php?option=com_content&view=article&id=101&Itemid=110

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  28. Well, my belief is if you respect Michael, you will be methodical in making sure you speak the truth and Michael is not the person to be using as a poster child for addiction--it is not being honest and if you are not honest then you are doing nothing for him but hurting him further. It is not only disrespectful to Michael, his children, and his legacy but it will give people the wrong views of addiction and many already have a very distorted view of addiction and what it really is. People actually suffer and even die from misconceptions and misunderstandings about addiction.

    JVM is definitely malicious with her words and she is simply using addiction as a way to make herself some money. I mean, to call Michael Jackson a "pill popper" is just dumb when a) he had no pills in his stomach when he died and b) he did not appear to be taking his oral medications in excess, especially in the last few years of his life when you take into consideration information from people like the Cacios, etc. He did not have any ill effects from years of abuse--he died in very good health minus some complications that seemed to be lupus. Everyone keeps throwing this blame and fault on Michael and addiction from some type of self-medication from depression from the abuse allegations and neglecting the fact he survived all that crap, he likely had lupus, and an MD was in the house poisoning Michael nightly and is directly responsible for his death. He did not die from addiction. He did not die from a disease. He died from Murray and he died from greed.

    I may get around to contacting this guy at some point but like others, I think the information would go in one ear and out the other and he would continue to publish whatever he's written as-is. Like you said, we have bigger fish to fry! I think it is better for me to just write out the truth and let people find it rather than going head-to-head with someone who could care less about what I have to say. Let's see what else he comes up with, otherwise, most of my work is revolving around Murray for the time being. That is enough to keep me busy for years!

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  29. Here is another good link courtesy of VPB_Maria on Twitter:

    http://www.contactmusic.com/news.nsf/story/jacksons-former-publicist-dismisses-family-intervention-reports_1109305

    I also need to talk about lorazepam again. I keep thinking of making it a separate blog or just adding it here, not sure what I should do. I made some mistakes in my math when I said Michael was given about 8 mg of lorazepam. It was more like 17 mg. :-(

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  30. Nikki, I have a question: what is your professional opinion about men who claim to have a "sex addiction"? Celebrities like Tiger Woods, David Duchovny, and Eric Benet have all claimed to have it and went to rehab for it.

    I know as a woman you probably think it's BS, but as a medical professional, is there any validity to their claims, or was it just a "get out of jail free" card that they used to justify their infidelities? I've always been curious about this! :)

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  31. Haha David! Interesting you bring that up right now as just the other day I read an article on "sex addiction":

    http://www.time.com/time/magazine/article/0,9171,2050027,00.html

    I think the whole notion of "addiction" has been blown out of proportion and now it has confused a lot of people. I think society is trying to paint everyone as an addict to something and that is not good. Have you seen that new show where people are "addicted" to pillow stuffing or abrasive cleaners or they have to carry a ventriloquist doll around? I don't know whether to think they really want to do such things or if they are doing such for hype so they can be on a TV show.

    As for "sex addiction", my current belief is it is not addiction like that of an addiction to heroin or cocaine, or even alcohol. I am not saying these men may not have the desire almost continuously (don't most men think of sex a hell of a lot, though?! LOL)--I do think that is very possible, but I do not think that gives them the excuse to go have sex with multiple women/partners like Tiger Woods (or Conrad Murray, hmmm). Did David Duchovny have any affairs? Is he still married to Tea Leoni? I could check on that myself I guess but I am lazy today.

    I really cannot imagine going to "rehab" for this sort of thing and if "rehab" works then you have to think it is moreover just acting upon pure desire than it being a compulsion that is taking over their life--I have wondered in the past if it is not a hormonal issue or something pathological with some of these men, at which case, a person I do not think could help what they are feeling if that is the case (which I don't know if anyone with sexual addiction has ever been said to have something wrong like excess testosterone or not). But, no way am I ever going to say sex addiction is an excuse for Tiger Woods having sex with just about every woman in Florida (or wherever). There is a difference between "thinking" and "doing", a BIG difference. There is a moral obligation there that should be met and should also be considered--Tiger may have had the continuous urges but he consciously decided to have sex with all of those women while knowing it would hurt others (his wife, children, career). Some men discussed in that article I posted did not have sex but instead masturbated on a frequent basis--at least the moral obligation to others is not a problem there, though physical harm might be!

    As for Tiger and other men who sleep around, I think they are pigs of course. Him and John Edwards have to be two of the men I hate most in the world (I think John has what's coming to him now that he married a nut). I think Tiger is just an asshole narcissist and did what he wanted and thought he could get away with it and did not care about anyone else in the process.

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  32. Part One:

    Hey Ebony! I finally got around to finding that quote from an article I wanted to share with you. The following comes from an article written by Kranioti, et al.

    "Propofol lacks affinity to opiates, benzodiazepines, or NDMA receptors and hence does not have the potential for abuse or addiction that is always associated with the risk of overdose, as in the case of fentanyl or ketamine. The abuse potential of propofol has not completely been defined, but there have been few publications describing propofol abuse and dependency. In most of these cases, propofol was abused for its sedative and relaxing properties. Other possible motives for propofol abuse are sexual illusions, pleasurable or euphoric feelings. In addition, propofol has been reported to alleviate symptoms such as chronic headache or migraine. Patients who use propofol for such reasons may develop some psychological dependency because of their addiction to the euphoric feelings induced. This however would seem rather to refer to an underlying psychological instability or disturbance with or without dependence to other drugs because most abusers do not develop true dependency to propofol since there is no evidence of tolerance, which refers to the need to increase the amount of drug to maintain a given response."

    This article came out in 2007 so it is still fairly recent and would be considered "in-date". Though this article says the abuse potential has not been completely defined medical personnel who administer this drug (physicians, nurses) will tell you they do not see the formation of addiction or the desire to abuse the drug in practice (though some patients have joked it gives them the best sleep they ever had). I have said before that I cannot deny that if Michael did in fact ask for propofol then his asking was to "abuse" the drug though he would not have seen this as abuse--he saw it as an IV sleep aid.

    Cont...

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  33. Part Two:

    I also want people to keep in mind abuse and addiction are NOT the same thing and that is crucial. One does not have to be addicted to abuse a drug--and being addicted/dependent on a drug is not necessarily abuse, either. I think it is important to understand Michael had asked for propofol so he could sleep--he did not want to use it to experience a euphoria or any type of pleasurable feelings. (I will touch on this notion a couple more times.) He just wanted to be able to sleep so he could be rested and perform at the level he knew he had to perform to basically keep everything he owned (and all that he owned is what generated his income that he and his family survived off of especially after the 2005 trial). This wasn't just a comeback on the line--it inevitably became his life on the line. But, my point is he was asking to basically be put into a coma--he did not know it was a coma (but Murray should have known this). Propofol can also be used to lightly sedate someone to the point where they remain able to respond touch and commands--this is all controlled by dosing, dosing that should be controlled by a manual IV pump that can deliver precise and exact dosing. That light sedation or "sub-therapeutic dosing" is what is said to sometimes cause pleasurable feelings. However, Michael was not seeking sub-therapeutic or light sedation. He wanted to sleep/be placed in a coma so that further rules out that Michael wanting to experience any type of "high" from this medication which has been indicated to possibly cause psychological addiction.

    As I have said before anyone can form a psychological addiction to just about anything though--but as this article states there is usually something underlying psychologically that is causing such, not the drug itself. The reason this is important is because Murray not only claims he was "weaning" Michael off the propofol (at doses that would barely generate an effect) but also there are now claims Michael drank propofol because he was so dependent on it. This new claim appears to be Murray's newest defense, as in defense number "too many". Perhaps the defense caught wind Michael's fingerprints were not on the syringes he supposedly self-injected with, against all logical and ability. Who knows.

    The link to the story reporting Michael drank propofol:

    http://abclocal.go.com/kabc/story?section=news/entertainment&id=7986544

    My Twitter response to this article:

    http://www.twitlonger.com/show/92hvjk

    Propofol is called "milk of amnesia" for a reason, too. Shortly after being administered (approximately 30 seconds) and until it wears off you do not recall anything--it is like time disappeared. So, any feelings of euphoria or sexual illusions should not really be able to be recalled by someone who is made comatose by the drug, as Michael asked to be. In other words, these pleasurable effects that sometimes lead people to abuse propofol should not have been factors that Michael should have experienced (or recalled that he experienced). Just repeating myself a few times to get the point across Michael was NOT physically addicted to propofol like Murray is trying to make out like he was. (Thanks to meigadas for reminding me about the amnesia effect!)

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  34. I figure everyone here also knows or can guess at the difference between physical addiction and psychological addiction. If not, let me know!

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  35. I really can't wait to see them try to produce a defense for this case. They have already pissed off the judge and the trial hasn't even started yet. And I seriously doubt if there is a real expert who would be willing to stake their professional reputation on this sinking ship of a propfol and demerol addiction, in which someone who according to them was very well versed in these drugs would be dumb enough to try and drink one and yet their autopsy does not support any of these claims.

    Everyone is concerned about Michael's legacy and his family, but I honestly believe that Michael's legacy already is. He was the greatest entertainer ever! And his family regardless of the outcome of this trail will always be tortured by his trials.
    I think the ridculousness of this all and the fact that it will be televised will just prove what Michael has always insisted. That People have always been out to get him, and people will say and do anything for money.

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  36. Their defense will be to try to blame the victim and confuse the jury as much as possible. I PRAY there is no expert who is willing to do exactly what you said but man, money and their name in the news may be the key motivator here! People are sick, including "experts"!

    To me, Michael's artistic legacy is set--there is no way anyone could ever lay a finger on his artistic legacy. No one. My worry is what do people think of his character? I do not want people thinking he was a pedophile nor that he died from his own drug-related demons that apparently did not exist, certainly not how people make them out to have existed. That is not fair. If people think poorly of his character they miss the artistic legacy he left behind and that is such a great shame because his entire life was devoted to either his work or to helping others, especially children. My hope is people his children's age will someday ban together and defend Michael against the few ignorant ants who try to defame his name. We have seen a bit of a spiritual/religious awakening in society in the last few years or decades--let's hope the same sort of awakening happens for Michael and the truth about the man behind the music. That is my hope, at least!

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  37. I wanted to add here that we now know that Murray used Luer-Lock syringes with needles--and non Luer-Lock tubing and IV catheters. The syringe on the table did not have a needle attached to it. It was long thought that the "needle" on the floor went to the syringe but this is incorrect. What was on the floor was actually an IV catheter, not a syringe needle. Thus, there was no needle around that was seen that went to that particular syringe (perhaps the one that went with the syringe was the one Murray offered to paramedics--ew.) Given there is no needle on that syringe, that means Michael could not have used it to self-inject in tubing that required a needle. The only other syringe found was found in the tubing. I will describe this in another blog, as it appears to have been staged by Murray after paramedics took Michael down, but will say for now the biggest indication Michael did not use this syringe is that it did not contain any of his fingerprints. No fingerprints--no self-injection.

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