Thursday, March 17, 2011

"But I Have Got to Pee..."

I have a new finding that I would like to share with everyone tonight that was meant to be a comment to my previous blog posting but became too long. I was talking with a dear friend today and it occurred to me to examine Michael's urine output. I wish I did not have to cover this topic but is important because I think this further proves that Michael was sedated when Murray did in fact give the propofol to Michael which then begs for the question--why would Murray give Michael propofol if he was already sedated?

Apparently 450 mLs of urine were found in the bottle left at the house and 550 grams (which is roughly the same amount in mL) was found in his bladder. His bladder, according to the autopsy report, was "distended and trabeculated". It was distended from the volume of urine. Trabeculated means "characterized by thick wall and hypertrophied muscle bundles; typically seen in instances of chronic obstruction". Michael had obstruction due to an enlarged prostate which is common in men around his age. When men have an enlarged prostate they tend to "go a little way too often" instead of being to empty their entire bladder at one time.

I was reading a case study on a young male nurse who died from propofol abuse. His cause of death as well as his estimated amount of propofol administration was estimated through his propofol urine content. The nurse's urine was found to have contained 5.4 ug/g--the bottle of Michael's urine found at the house had less than 0.10 ug/g and the urine from the body had 0.15 ug/g of propofol--much less than the nurse who died. This report estimated that the nurse had died after accidentally giving a 200 mg dose of propofol too himself too fast--but before he died, he'd given himself at least eleven 20mL (200 mg) doses over about six hours (roughly 2225 mg).

This report on the nurse also said that the typical person produces about 40-50 mL of urine an hour. Okay--450 mL divided by 50 mL gives you about 9 hours of urine in the bottle at the house. If you divide 550 mL by 50 mL you get about 11 hours worth of urine in Michael's bladder. Whoa. We do not know when that urine in the bottle was voided, we do not know if it was voided at one time or collected over so many hours or even days. However, it seems it may have been urine released over that night because of the similar content to the urine found in Michael's bladder--both contained propofol, lidocaine, ephedrine and midazolam (noticed the midazolam/propofol amounts "flipped" in the two samples--more propofol found in the bladder than the bottle and more midazolam found in the bottle than the bladder which seems to indicate the urine in the bottle was voided sometime that night, probably in more than one voiding).

In a normal person (as in, someone without diabetes insipidus) , someone usually makes urine in proportion the amount of fluids they take in, so, a person who drinks just a little bit of liquid should not pee as much as someone who has taken in a lot of liquids. Murray claims Michael was dehydrated--so Murray may have actually given Michael a lot of IV saline fluids, either for dehydration or some other reason (perhaps a reason like Monica hinted at, for example).

So, assuming Murray gave Michael a lot of fluids, for whatever reasons, it caused Michael to produce a lot of urine. Here is where the problem occurs--Michael had 550 mL of urine in his bladder. A normal bladder comfortably holds 300-350 mL of urine. A "full" bladder holds about 500-700 mL of urine. Michael's bladder had about 550 mL of urine in it so his bladder was at capacity. The desire to urinate begins to be felt when the bladder is at about 25% of its working value--so, if the working volume was 400 mL for Michael then at about 100 mL Michael should have felt the need to pee. Whatever the percentage, at 550 mL Michael should have felt the need to urinate and urinate ASAP. But, Murray claims Michael was awake, "demanding" propofol. Really? Michael was awake yet did not think to empty his at-capacity bladder? In fact, Michael should have felt the urge to go well before he passed away but yet died with a full bladder but Murray insists Michael was awake all this time. I seriously doubt an awake Michael consciously held this much urine and did nothing about it, hell, he did not even have to get up to pee since he had a condom catheter on--I think almost certainly Michael was sedated thus did not feel the need to urinate and that is why his bladder was full. He would have peed had he been awake during all that time when Murray claims he was awake demanding this and that and what not. With Michael creating that amount of urine and holding it all that time one has to ask if Michael EVER awoke at any point on June 25th before he died? It does not seem likely from my point of view.

Let us not forget the autopsy report also lists "benzodiazepine effect" as a indirect cause of death. This indicates that Michael was in fact being sedated by the lorazepam given to him. I mentioned before that Michael was given a large dose of lorazepam. An expert who testified at the hearing in January said his estimate of lorazepam given was 7-12 mg--a far cry from the 4 mg total Murray claims he gave that night. He also said he thought it would have been sedating him. He also estimated the amount of propofol given was somewhere between 100-200 mg--a dose that should not have caused death in Michael had he not been being sedated by lorazepam in the first place which together these medications caused Michael to not be able to breathe on his own. (I hope to soon be able to directly quote the expert on the findings above as they cannot be verified at this time since the transcripts are no longer publicly available online. I also hope to try and come up with his findings as a way of double-checking everything at some point since an expert is not always right. Estimating the doses Michael received is very difficult given possible reasons such as being over-hydrated, decomposition of propofol in plastic containers, multiple administrations of certain drugs rather than just one dosing, etc. I am not sure if the amounts quoted above are meant to indicate terminal (last) administrations or cumulative administrations of the medications, either.) However, Murray is lying about the dose and time he last gave lorazepam. Murray has lied about the dose of propofol he gave. He has almost certainly lied about Michael being awake during this time--WHY? Why do you give propofol to a man who is sedated and why do you claim he asked for it when he could not ask for it because he was already sedated?!

One thing I am still puzzled about is why were so many bottles empty at the scene. Two lidocaine bottles were empty and three others had partial amounts of drugs, two 20 mL bottles of propofol in addition to a 100 mL bottle of propofol (propofol should be discarded after 6 hours of being opened). I do not know if these were used during previous nights or if they were emptied as a part of staging a scene or something. Murray supposedly used no propofol the night before (thus should have used no IV lidocaine, either). Looking at Michael's urine levels it does not appear he had been given that much propofol before he died, certainly not any grand amount over 6 hours as was the case with the nurse died. It is difficult to make all these assumptions given Murray has done nothing but lie and evidence was not preserved properly if preserved at all. It will always be hard to state anything as 100% fact concerning Michael's death but I, and others, will try our best to piece everything together in time as more information comes out of the trial and I learn more information scientifically-related to this case.


  1. Hi Nikki,

    I'm sorry to ask what might be a dumb question, but if he was wearing a condom catheter, why is his bladder so full? I hope this means the person who reported this was lying, the one who said Paris saw her Daddy in that state, it is a horrible image for a little girl to have of her hero. I always hoped that it was fabricated...

    Bur perhaps, I don't understand the role of the catheter correctly?

  2. As hard as it is to read about Michael in this state, it is crucial that we ask questions like this, and you have once again done such a fabulous job in asking all the RIGHT questions, Nikki. Indeed, why was his bladder full and not empty, if he was, as Murray claims, awake for much of the night? So many questions still remain outstanding. The CCTV tapes deleted, the empty bottles, the syringe...all of this and more points to something much more sinister and disturbing than 'accidental manslaughter'. I just pray that the prosecution are as detailed and meticulous in their thought processes as you are, Nikki.

  3. No disrespect as this is a very detailed explanation (thank you), but I am wondering the same as the person above. I was under the impression that a condom catheter would allow the bladder to empty on it's own when someone was sedated. Can you explain that aspect more fully? Thank you. Just trying to understand better.

  4. I have learned so much in reading your blogs. I hope every concern/question you have raised is brought up in court by the prosecution. I don't see how in the world Murray was charged with only manslaughter. It should be second degree murder at the very least.

  5. Hi Nikki, this follow up to your last previous blog is very interesting, If Michael was awake begging for propofol, and had a full bladder, why wouldn't he get up to go (while he was "begging") or just go into the attached condom catheter while "awake"? He didn't even have to get out of bed! The amount of urine remaining in his system at death is striking.

    When you ask "why do you give propofol to a man who is sedated and why do you claim he asked for it when he could not ask for it because he was already sedated?", do you think possibly Murray wanted some "insurance" that Michael would continue to sleep? Then, when Murray loses his patient, comes up with the excuse that Michael could not sleep, was awake, and "he begged for it."

    There is an interesting interview in the February 28, 2011 NY Times of Dr. Emery Neal Brown, professor of anesthesiology at Harvard Medical School and a practicing physician at Mass General. The interview is entitled "Call It a Reversible Coma, Not Sleep"; while I can't post a link, I'm sure it can be found by googling. Makes me wonder if Michael signed a medical release before being put in a coma.

  6. 3rd attempt at posting this...

    Same question as Karen - how was his bladder still full? I appreciate his prostate problem, but wouldn't a catheter bypass this to keep a constant 'exit'? Surely once asleep, muscles are in total relaxed state and along with a catheter, make emptying the bladder even easier?

    Not quite worded that as I did the first 2 Fascinating blog tho Nikki - and thankyou for always making it understandable for those of us who don't have any medical training!


  7. A condom catheter uses a type of large condom with a tube attached to it for the urine to flow into the collection bag.It still relies on the bladder capacity to release the urine. If he had not been wearing a condom catheter he would have wet the bed and the bed had what we commonly call chux on it to prevent soiling the linens.I'm trying to mull that out because it doesn't make sense that his bladder still had urine in it at all.

  8. Got to keep this reply short as I am on a bad computer and have a bad connection--a condom cathter does not actually enter the body--it is external and merely collects urine as it is released from the body. It does not help one to urinate or anything like that--it simply collects it and keeps it from soiling the patient, as Lynette mentioned. I, too, am puzzled why he had that much urine in his bladder. I will try to research for a reason but certainly I would think had he been awake he'd have relieved himself well before allowing his bladder to get that full as I don't think he would have been comfortable with that much urine in his bladder--if awake he should have been peeing whie awake. That amount of urine in the bladder would not be produced over minutes or even a couple hours--though how much fluid Murray was giving him would effect how much urine he was making. Interestingly Murray did not order a lot of saline bags--I think he ordered 9 bags on April 6th and then 12 saline bags on June 15th. I find that kind of curious and interesting.

  9. Hey June, you asked "Do you think possibly Murray wanted some "insurance" that Michael would continue to sleep?" Not really, I mean, if you want him to continue sleeping (and by this time it was WAY past time for Michael to get up and start his day) then he should left him alone or used one of the benzodiazepines since they last a lot longer than any dose of propofol (and they are safer, too, not that Murray would care). A dose of lorazepam would roughly last 6 hours, a dose of midazolam about 2 hours (assuming a "basic" dose). Propofol only lasts minutes and the risks for problems are far greater.

  10. I am limited in my abilities to search but this link may provide us with some answers:

    Perhaps Michael was suffering from a condition dubbed "neurogenic bladder"--the brain is not able to tell the bladder it is time to empty so the patient cannot urinate. A common cause--general anesthsia. Hmm--I guess that would mean Michael had to have been sedated. Nerogenic bladder sounds very reasonable---Michael likely died because the propofol interfered with the brain signals to breathe, before that the medications seem to have affected the signals to pee, though.

    What is your thoughts on this Lynette? Can you add anything else?

  11. Simple. Murray killed Michael with drugs to difficult his sleep, and to pretend it was an accident.

  12. Excellent post! Excellent questions!!

    Looking forward to the updates.

  13. I just thought of something last night that has left me a bit confused on my previous comment--what about that urine in the closed bottle? When was it voided? Was it collected over days, hours or minutes? Murray claims that he did not give any propofol the night before and if I recall correctly (and I would need to double check this) propofol usually stays in the urine for about 24 hours. If he developed a neurogenic bladder how was the urine in the bottle voided if it was in fact done so that night? Was it shortly before death (and some of that urine was from another time)? I don't know, I need to think about this but cannot do it right now as my time is limited. I will try to get to the bottom of this.

  14. Thank you, Nikki for expanding on this. I remember when these findings (autopsy report) came out. I was struck by the catheter use and really made a mental note that it was, imo going to be important in the case. It bothers so much because well, I feel it says so much about intent and projection of thought (CM); still so murky for those of us who care for Michael (as you said, "a knife in the heart"). Perhaps if we flip flop the situation and work backward from the whole, awful point of approximately 1pm on June 25 to say, 24 hours prior or even back to April, the larger picture will become less blurry. I do feel like we are looking at this with foggy, smeary glasses on (strange, I know). Anyway, that's just me. Nikki, your research is so clear. Thanks so much, really.
    But, one more thing...the claim Michael was "demanding" propofol-is it possible that Michael started to come out of it at some point early in the am hours and just b/c he was totally out of it and basically on autopilot, thought to himself, "Damn it, I'm still awake, I've been trying to get to sleep all night" and mumbled something about, "Can't you do something for me?"(?)-Then CM just used this as his excuse for dosing Michael with propofol, knowing full well Michael was not "Michael"? Doesn't midazolam cause amnesia and relaxation such that anything a person would verbalize would be the result of a brain on what I refer to as "autopilot"? Surely a physician would know this (?) (Basically, CM just grasping at straws). I just know if I have trouble falling asleep and I become lucid I say this to myself and become irritated. But anyway, don't get me wrong I do not take CM's excuses/words as objective truth and of course this scenario paints a picture of a more bumbling Murray rather than a calculating Murray and I don't think we should rule out the latter, especially in light of the real possibility Michael never even saw the light of day on June 25.

  15. Excellent, keep the questions coming. Thank you so much for your efforts. Could the 550ml of urine possibly have been produced during the resuscitation period, they would have given him lots of fluids in the ambulance and emergency room to get the heart and kidneys going. That is one of the reasons there was a discrepancy with this weight.

  16. I'm still confused by the amount of urine still in Michael's bladder at the time of his passing. The AR stated that Michael had a mildly enlarged prostate. (Please correct me if I'm wrong.) Would this have led to the bladder not emptying even if that condition was mild? How much will a full bladder empty on its own when a person is sedated and not able to control this function themselves? As you have noted, Nikki, if Michael was awake shortly before he passed, it would have been very natural for him to relieve himself as a result of the discomfort he clearly would have felt. I also imagine that he had been using the condom catheter for awhile at this point and would have become acustom to using it. I'm sure it was an awkward sensation the first time he used it. The idea, likely to be presented by the defense, that Michael somehow dosed himself shortly before his death just doesn't make sense in light of this very simple fact. To dose himself, I imagine he would have to sit up to some degree and bend at the waiste, obviously. This action alone, I would imagine, would initiate a very strong need to relieve the discomfort in his bladder, I would go so far as to say painful discomfort.

    I can't help thinking how horrified Michael would be if he knew the world was discussing his personal business this way. I guess there is small comfort knowing he doesn't have to deal with that...:-( So much doesn't make sense but I thank you Nikki for adding clarity to all this and I admire how you have handled these sensitive issues in an honest, intelligent and respectful way.

  17. A few years ago I have a major surget and I remember my doctor have me sign all the legal papers because on my no blood issue he told me that once he medicate me any document I sign would not be valid,
    I am asking is this the same procedure in the USA?
    because if that is the case then anything Mj was "begging" for he was under the influence of the drug Murray had gave him before.
    I am still baffle that Murray would feed Mj all those drug and turn around and say he never gave him anything to kill him.
    Any doctor will tell you all those drug mixed are a recipe for death.
    I too ask the same question if Mj was up why the condom catheter?
    All the evidence point to Murray putting Mj to sleep for many hours
    1) he was wearing condom catheter
    2) the bed was prepare with bad pad for an accident
    3) he was string up with a iv drip,
    So Murray are you saying that, what you gave MJ was not going to knock him out for a while?
    I do hope they have a reenactment in court have Murray leave the room for two minute and have a patient under that much drug try to self medicate in two minute.
    Niki you did a wonderful blog and point out some key point, thank you

  18. I forgot to ask a nagging question , all that dipavan Murray had Oder do you think he gave some to his medical clinic?
    Just wondering

  19. There are short procedures wich you don´t need to catheterized the patient´s urethra.This kind of patients used to wake up with distendend bladder, and can take hours urinate by themselves, they feel the need to urinate, but their brains can not send the order to the detrusor muscle. This is caused by the lack of communication between the brain and the detrusor muscle, and its cause the effect of anesthesia.called neurogenic bladder.This kind it´s not pathological, its effect lasts only a few hours.until the communication is unblocked. So MJ could not urinate on. He couldn`t feel the urgent to do it, or could not do it for his blocked detrusor.

  20. Hey Sandy,
    Yes, just the thought of Murray having a condom catheter on Michael irks me--this was a man without any health conditions that should have required a condom catheter and to think Murray was sedating him so heavily that he was losing his own control of his bladder is beyond disturbing and it is pisses me off to think Murray could prepare for this but not for the apnea or hypotension. Now, I say that, but we do not know if Murray had ever placed a condom catheter on him before--or was it just for June 25th? I do not know.
    As for waking up at some point right before propofol administration--no, I do not think so or if he did, then he was heavily sedated on the lorazepam prior so it should have taken effect prior to any propofol administration, based on the amount in the AR which then still takes us back to "why"? The midazolam had already worn off by the time the propofol was given (but yes, midazolam does cause amnesia, big time). You have to think, even if he had awoke, why in the hell would Murray listen to a groggy Michael? Michael would be in no condition to attempt to dictate his own treatment (and Murray would know this, he is the doctor and the one who should be looking out for his best interest but did not in any form) and it still bothers me that supposedly over all that time Michael was supposedly "awake". Plus, if he had just awoke, why would he want to be put back to sleep since it was time to wake up? Just more confusion in this web of lies.
    The enlarged prostate (I do think it was mild, but would have to double check), the way I understand it is a guy can pee it is just he cannot get all the pee out--thus they find themselves needing to pee often but it is usually not in huge amounts. It should not prevent a man from peeing--if a man finds themselves unable to pee then a trip to the doctor or ER is warranted ASAP. I do not know how much urine the average person releases when sedated or what not or anything like that, I think usually when sedated they do not pee at all until after surgery but I could be wrong. People who go to surgery have catheters placed internally, too. I know that sometimes when a person cannot pee an internal catheter will be placed and that will allow them to finally "go". I hope I hit everything you mentioned and did not miss anything!

  21. Hi Ginger,
    As for the fluid in his bladder that would not have been from when he was being resuscitated--he was deceased by that time so his organs were shutting down if not completely shut down by that time. But, if they gave fluids they could have added weight to him, to his blood volume, but I do not think it would have been almost 25 lbs. worth, no way. You can actually kill someone by giving them too much fluid, too. I have began to wonder if part of the discrepancy is from when the weights were taken. The coroner said 136 lbs--sure, some of this may have been from fluid but Karen Faye has said the mortician said he weighed about 110 lbs. But, this was some time after the autopsies so I cannot help but think maybe there was some effect on weight from this time lapse. I do not know for sure, I am speculating, I do not know what effects that time lapse could produce on weight but I'd imagine there would be some type of effect since the body is mostly water anyway. I do not think the coroner lied about his weight, at the same time, I do not think Michael was at a "healthy weight", either.

  22. Hey Bridgett,
    When you have surgery or a procedure in the US you have to sign paperwork, some of which are called "consent to treat" papers. They are valid during surgery. A doctor must explain the risks to you and what they will be doing to you and you need to understand them before signing the papers saying yes to the surgery or procedure. I have said with the dangers that Murray was placing upon Michael he should have made up a "consent to treat" that could have protected his own ass but he did not bother to even do that, Michael did not even sign the contract for Murray to be paid and that named Murray his doctor. No doctor would willingly want to do what all Murray did to Michael, certainly not one with a conscious or care about his professional status, either.

    "I am still baffle that Murray would feed MJ all those drug and turn around and say he never gave him anything to kill him.
    Any doctor will tell you all those drug mixed are a recipe for death."

    So true, so true, so true!!!! I am baffled by it, too, because it is such a lie.

    Supposedly Murray first ordered propofol on April 6th (yet a week later Michael was talking to Lee about it wanting a doctor to give him this drug that helped him sleep, or so he thought)--Murray removed some of the bottles out for his office in Las Vegas and had the rest shipped to California. Now, I do not know why he did this. I have began to wonder if Murray was using propofol on other people or something. He should not have been using propofol on his patients unless they were in a hospital for a very specific problem. Thing is, in Texas I do not think he had any privileges at a hospital anymore. A cardiologist can only do so much in his office--some of their job requires they be at a hospital, too. I do not know where he was a doctor at in Las Vegas, as in, what hospital, if any. Just him having two different offices in two different states bothers me. I have worked with cardiologists before and the ones I knew all worked in the same city and that alone was busy enough--they worked like dogs. They may have two offices in town, or they may have had privileges at more than one hospital, but they certainly did not have time to go from state to state--some of their patients needed to see them monthly if not every two weeks or sooner and I think most of the doctors were at the hospital every day--unless they were off and a doctor was on-call for them (covering for them). Some cardiologists I knew would work like, a month straight, all 30 days, then take off a month, not to work, but to rest! So, I am not what Murray was and was not doing. Whatever it was does not sound right to me.

  23. Meigadas! Did you see my link above on neurogenic bladder? This is what I was thinking he was suffering from--but I was not sure.

    Now this links says they can feel the need to urinate (once awake) but cannot pee. My question is--does this indicate that at some point that night Michael was in fact sedated, if not all the way up the point of his death? As in, his bladder/brain communication could not be effected this strongly yet somehow the medications fail to sedate him, right? Seems if he did in fact have the neurogenic bladder condition (which I think he did) then he definitely had to have been sedated. Thus far Murray has never said Michael commented to him that he needed to pee. I wonder if he had ever suffered from this before because of Murray drugging him at night? So, either he was so sedated he could not feel the need to pee or the nerve impulse was blocked BUT Michael should have complained to Murray he needed to use the restroom and it should have been a very uncomfortable condition. To relieve this he'd need to have been given a foley (internal) catheter. Sound right?

  24. Also--this would not prove that he in fact remained sedated the entire duration of the night (but it is possible) but likely had to have been sedated at some point and sedated quiet deeply (not just the basic sedation seen in sleep). He could have awoke but either remained sedated or was re-sedated on lorazepam first--as his blood level was quite high so the lorazepam had a chance to circulate into his blood--so by all means he should have been out when given propofol, still. Had he awaken at some point that morning he should have complained about the need to pee and it should have felt urgent however he may not have been able to pee due to neurogenic bladder--that should have had precedence over this desire to be "knocked out" one would think. Or, he had the neurogenic bladder and never woke up to know he was unable to pee--do I have this right meigadas? Check me for errors! ;-)

  25. Hi Nikki,

    You responded to Ginger concerning the wieght discrepancies that have been reported about Michael at the time of his death. As you stated, the coroner said 136 lbs and, per Karen Faye, the mortician said 110 lbs. Could it be the case that Michael's body would have been lighter after both autopsies were completed due to the removal of fluids, such as from the bladder, and tissue samples? I realize that 26 lbs is alot to account for. I would also imagine that the body was dehydrating over the 2+ months between the time of death and burial, as you note the body is mostly water. Also, it had been reported that it took a while for some internal organs to be returned to the body such as the brain. Ugh. In addition, it has not been stated when the mortician weighed the body, this timing would clearly make a difference. Sorry for these kinds of details. This is difficult stuff.

    By the way, it would be interesting to know if anyone here knows a coroner/mortician/forensic pathologist that might have an idea how much mass a body loses after death, especially after 2 months.

  26. Oh Sandy, I had this big write-up to post and I think my blog ate it!! I just feel like crying!! AHHH!!! So, I will abbreviate now...

    I agree--I think that most of his weight loss was from water loss from evaporation/dehydration over those two months. I just hesitated to say it because this stuff is difficult when we remember we are talking about someone we care about so much. I figure his body was frozen during that time before burial, and with all the things going on some water was loss, along with the items you mentioned, but I think water was the main cause in the weight change.

    I sometimes wonder if Ed Winters' scales are off--his stated weight for Brittany Murphy seemed to be weigh too much, too.

    My guess is Michael weighed somewhere in the upper 120s--resuscitation efforts and administration of fluid that night added some weight then some was lost over those two months--mostly water by various means.

    I wish a coroner/mortician/forensic pathologist would give us some insight. I do not know any personally myself.

  27. Gato! I saw the link. And i totally agree with your hypothesis.
    An adult male´bladder has a 1500 ml aprox. of capacity. Mj was been medicated with FLOMAX. From the vedemecum:
    "Flomax (tamsulosin) belongs to a group of drugs called alpha-adrenergic blockers. Flomax relaxes the muscles in the prostate and bladder neck, making it easier to urinate."
    So if MJ wake up only for a few minutes or seconds he would run to pee before "begging for".Although he would suffering a kind of neurogenic blodder for anesthesia, he would stand up and try to pee by himself.No more "beggingforhismilk" nonsenses, please!!
    It is so bizarre that i sometimes think that is a screenplay written by Amodovar. But is MJ, is not a screenplay and i´m not jocking.
    Condom catheter, we don´t use it in Spain, unless you were conscious or you urinate by overflow. there´s no other motive.
    But al seems to be bizarre.
    The protocol paramedics followed was no coherent. In Spain, emergency team would stop the CPR before 40 minutes in a case like that, wait for the police and for the judge to stand up the deceased.
    No logic.

  28. Sorry lady, yesterday i had got to written fast because my conexion was failing.I lkost all the response twice, and the third i was so mad with my computer that i had to resume what i wanted to say.
    I wanted to point that you were correct with your hypothesis not only for common sense ( soemtimes i think we are full of it comparing to some DEA investigators...specially who loses important information recorded on videotapes, if that is true...sic!) but for physiological reasons.
    His kidneys were producing urine from:
    1. A long time being sedated and it´s important to point sedated because i refuse to call it "asleep", if MJ were awake for whatsoever was the period of time, his primal need would be to pee ( hours are needed to collect this amount of urine without drinking)
    2. A short period of time receiving an infusion of serums via IV, at least the same that was inside his bladder: 500ml. But if he was awake during the infusion he would feel the need to pee also.

    The AR don´t say there were a sphincter relaxation, so no urine for overflow...but i think this problem would be considerated by Murray and MJ because the AR describes the bed with a plastic cover, so I can assume that MJ was deeply sedated nights before 25th. Deeply enough to don´t feel the urgent to stand up and go to urinate, and a long time sedated enough to pee for overflow ( remembering that to urinate for overflow you have to increase the amount of urine inside the bladder to aprox. 800 ml, it depends of the total capacity and the the patient´shealth, age... remember also the FLOMAX)
    I do not think that was the first night that Murray sedated MJ to such a profound way...counting the bottles and vials of propofol Murray ordered...

  29. Gracias meigadas!

    Yes, Michael had Flomax but did not seem to be taking it as he should which would have been on a daily basis (he did not even finish his antibiotics which is not good, either). The Flomax was written on June 3rd, he'd only taken 6 of the tablets! Surely Murray did not write it in an attempt to treat the neurogenic bladder--you never know with this quack.

    To my knowledge condom caths are only used in older men who have incontinence problems (ex. maybe someone with Alzheimers). They are never used in the hospital, only nursing homes. I wonder how many caths and bed pads Murray had ordered and if Michael was aware of these things being him/his bed?

    I totally agree with you--paramedics should have done exactly that--call police and refused to continue to render treatment to a deceased victim. There was no need to take him to UCLA--Murray fooled them by saying he should to go UCLA since he was celebrity--BS!!!

    I do not know what to think concerning this whole sedation business. I sometimes wonder if he was sedating him mostly on IV benzodiazepines and not propofol. I think the hair samples would give us a definitive answer, I'd hope. I say this because I would think that if Murray ever gave that much lorazepam before with that much propofol in a man with lung damage no less, he'd died well before June 25th. I just wish we knew WHEN Murray started doing what, and I really mean what, as in WTF?!

  30. I have some important bits to add here. Recall that the urine found at the scene had less than 0.10 ug/g of propofol and the urine in the bladder had 0.15 ug/g of propofol. I wonder if this discrepancy could be from the fact that the urine was in a bottle. If the bottle was glass, what I am about to say would not apply, but if it were plastic then one should consider the fact that plastic degrades propofol. This would cause a lower amount to be found in the contents of the bottle. This is why propofol is stored in glass vials and not plastic bags.

    Apparently, according to this site:

    Poster "Nomarks--Guest" says, "In nearly every PM (post-mortem) we easily extracted urine from the bladder, in varying quantities. Whether or not some leaked out at or after death is difficult to say."

    It seems from this poster that even if someone releases urine before or after death, some remains no matter what, and in Michael's case, there was a lot. So, is it possible Michael's bladder actually had about 950 mL (almost a liter) of urine but when he passed (or shortly before he passed) he released about half of the contents? This is speculative but if he did have nearly a liter of fluid in his bladder then there is NO WAY AT ALL he was awake that night, I mean, 500 mL is bad enough and already indicates he was not awake when he died.

    Remember the contents of the urine contained the same medications as the urine in the bladder so it seems they were from around the same time frame. The main difference is the midazolam in the urine--0.0068 ug/g vs. 0.025 ug/g. The urine in the bottle had more midazolam. I am not sure how significant these numbers are or if they could help determine when the urine in the bottle was actually released. I still think it is possible this urine in the bottle may have been collected during more than one release of urine, too, perhaps some early in the night (perhaps shortly after giving midazolam) and then some right before or after he passed (hence the propofol contents).

    I really wonder if Murray had a bag to collect urine or what because if he was collecting it in a bottle--regardless if he had a bag or not, collecting urine in a bottle?! Why? You collect then flush it! Was this bottle his only means to collect urine and if so why did he not have a bag?! I just do not see the point in having urine in a bottle when he had the condom catheter on or should have been able to use the bathroom as usual. I would think if there were a bag it should have been mentioned in the autopsy report as it should have contained urine that would have been tested, too.

  31. I should also have added above that if Michael was awake most the night I do not see him needing to wear a condom catheter nor do I imagine him wanting to wear such, either, as I am sure it is uncomfortable. If he did not wish to get up to use the restroom (since Murray had placed the catheter in his leg) then a bottle (I guess) or portable urinal could have been used. I would think for someone awake and who has normal urinary function (someone who can pee on their own at a toilet), peeing into a condom catheter would be difficult because it feels "wrong", especially while laying in bed. This condom catheter is used on men who do not have control of their urine outflow so they do not have that problem that someone like Michael would have. This whole situations irks me that we are even having to discuss something like this. The only reason I do is because I want to know what happened to Michael.

  32. I need to add something else that a friend inquired about that may be of significant importance. It is regarding beads mentioned in the autopsy report.

    I remembered there were, according to the autopsy report, a "string of beads" found at the foot of the bed on the side Michael was sleeping on, along with a tube of toothpaste (page 3). These items at the foot of the bed are odd but I have not figured out the meaning behind these items' location...yet. I did not realize the report stated on the same page, "there is a bruise on his left inner leg, below his knee and 4 discolored indentations were found on his lower backside". The bruise is from the IV Murray placed in the calf (again, a huge medical no-no) but the indentations are interesting and should be further examined.

    On page 13, the following is stated, "over the lower back are several 1/4-1/2 inch peri-mortem abrasions. (Comment: Scene photographs show beads on the bed).

    Now, does this comment infer that the abrasions and thus indentations are from beads? Were there some beads lying in the middle of the bed (thus under Michael's back), separate from the "string of beads" which lie at the foot of the bed?

    In pictures taken of Michael in the last few weeks of his life he was wearing a beaded wooden necklace. It is simple necklace, I have not seen anything on the necklace other than the simple wooden beads that all appear similar to one another. The beads are not complete spheres--where the beads touch each other they are flat, so it makes sense they could scratch someone (give them an abrasion) if pressed and rubbed against the skin. But--was this "string of beads" in fact the necklace he had been wearing or something else? If so, was it still a necklace or had it become a "string" by being broken at some point? If this is the broken necklace then why was it broken? These are important questions that need to be answered. If the answer is "yes" to the above questions then why was his necklace broken and why was part of it under him?

    On page 39 I have tried my best to make out the posterior (back) side of the diagram. The best I can make out is, with question marks used for words I cannot make out, "focal depigmentation of back--1/8 ??? 1/4 inch; Abrasions 1/4 - 1/2 inch (with "L" shaped arrow pointing towards circled areas).

    Okay, so what are designated as abrasions and what are designated as discolored indentations? Are the indentations from four individual beads or from simply lying flat on his back (pressure points)?

    I think the main point of all this is--the discolored indentations are significant regardless of whether they are from beads underneath him or from simply lying on his backside for an extended period of time. These discolored indentations would seem to indicate that Michael was immobile (due to sedation) for some period of time, including just prior to death. If these were beads under him then he should have felt them and had the urge to move them-- he could only do that if he was awake. The autopsy report seems to say these beads scratched him on his back sometimes right around the time of his death, too, which, if that were the case who moved him causing the beads to scratch him? Was Michael dragged or something from one location to another while sedated? Murray first seemed to indicate he found Michael alive then he seems to have found Michael dead so did he find him alive then "kill" some time before pretending to realize he was actually deceased or what? Anyway, back on track, if these indentations are from laying on his back then they formed due to him being sedated and not being moved or able to move himself for at least a couple hours, if not more. When someone is asleep they can move in their sleep--someone heavily sedated does not move, certainly not like that of a person who is actually sleeping. Someone sedated typically needs medical staff to reposition them every two hours to prevent bedsore formation.

  33. I want to make it clear these are not bedsores on Michael's back. I read some reports that claim Michael was so depressed he developed bedsores after the trial, blah blah, NO. He did not have bedsores when he died and likely did not back then, either. However, they may have been the beginning of what could have been bedsores if he was not able to move from being sedated. If he had gotten up that morning like he should have then any indentations would have gone away and caused no damage to his skin.

    These indentations imply there was some sort of pressure to his backside--period, be it from beads or his weight pushing into the mattress or something similar to that. There do not seem to be many other options as to what they would be from, that I can tell at this time, though photos would certainly help. The discoloration should indicate the pressure was so great to those areas of skin it affected the blood flow to the area before death. The discoloration and indentations remained after death since whatever caused the pressure was occurring before he passed away. This is the same principle that investigators use to know when a body has been moved. If someone passes away on their back the blood pools to their back--if investigators find them lying on their face but the blood pooled to their back then you know someone moved the person and they did not die in which they manner they were found.

    So, the comments above seem to be yet another indication that Michael was in fact sedated when he was killed. No demanding of propofol, no extreme, sudden tolerance to benzodiazepines, either.

  34. Nikki said "so, the comments above seem to be yet another indication that Michael was in fact sedated when he was killed. No demanding of propofol, no extreme, sudden tolerance to benzodiazepines, either."

    Yes, Nikki, as you have so succinctly pointed out several times, it does appear Michael was sedated, "out", from the benzos, etc., perhaps already dead, when Murray IV'd the propofol. Your blog and one or two others have reached this conclusion which I have long held; Michael didn't "beg" for prop as Murray (and Nurse Lee) would have us believe. Michael wouldn't "beg" for anything. It's a setup and someone is going to get Murray off.

  35. Hi Nikki, I need to think about this more but what would the scenario look like if, as June stated, that Michael was already gone when Murray administered propofol? I am kind of confused and need to look over your other posts regarding medication levels from Michael's AR, but would the fact that his body stopped metabolizing the medications have any effect on the levels not jiving as I remember from those posts?
    Oh, btw been missing your updates, but it gave me a chance to catch up on a lot of your info. A big help in my know when you really care about someone you really want to get it right and know all the facts. Thanks for that.

  36. It has been said(a hypothesis)that murray gave
    Michael enough for a good time of "sleep" at
    about 2am, left for his cocktail-stripper bar,whatever and returned 6:30 am,screwed up the heat to 90 degrees,end of June in LA!Started his frenetic texting and phone calls that morning for an alibi.
    BTW your post is exellent and your knowledge much exeeds that shown in in murrays trial.I cannot understand that the judge goes along permitting complex microbiology and pharamcokinetic test ,expensive and totally useless.You probably heard the inane story of having a pig drink Propofol.

  37. Thank you Anonymous! Sorry I am getting back so late. I am not sure I buy that story though I have heard it, too. First, did anyone see Murray there? Any footage of him? Surely it would have been shown by now. Second, there is no way he could have kept him sedated on propofol that duration without him being hooked up to a ventilator--he'd died. Now, he maybe could have been sedated on some of the benzodiazpines and left--that is true. But the problem with that scenario is the properties of propofol say it is impossible.

    Yes, sadly I have heard about the piglets. Thing is, that study was already done and it showed that rectal administration of propofol (which would also include oral) do not work. There is no reason to duplicate it. Anyone who knows pharmacology should be able to attest to this. Poor animals should not be subjected to this sort of abuse.

  38. Hi Monica <3--yeah, I have not been being notified that I have comments to moderate! Ugg. As far as Michael already being gone when propofol was given, no, because his body had metabolized some--it was in the urine. Now, I guess we could ask what if Murray gave propofol before, then other medications, and then he died? Well, not likely because the lorazepam would take a bit to get up to the level that was detected in the AR (it was very high and helped contribute to his death). Thing is, propofol is so short-acting I don't think the level could have been that high if it was given before the lorazepam. I hope this kind of makes sense. In other words, if Murray gave propofol then lorazepam, by the time the lorazepam was high enough to cause some problems the propofol level should have already fallen back to pre-anesthetized levels or at least non-fully sedating levels. This is all rough science I am spewing out--if we had some real numbers to look at (as in how much Murray really gave and when) it would be so much easier.

  39. I should add that to me, the numbers from the AR seem to tell me that at some point Michael was sedated on midazolam, then at some point Murray sedated him on lorazepam, an extremely high amount, then he topped the lorazepam off with propofol while Michael was sedated. I have mentioned before the urine in his bladder to me indicates he was sedated along with the fact that for the propofol to be lethal as it was (assuming only 100-200 mg were given) then it had to have been because the lorazepam was sedating--the AR also lists it as a contributing factor as well.

  40. Can't Murray just plead guilty. It's painful to see his attorney grasp at straws. It's the defense of desperation. The prosecution gave him a gift with a lesser charge. And MJ was his friend. MJ tried to help him by giving him this job. Instead of badmouthing MJ, just be a stand up man. A professional has a standard of care, and a responsiblity regardless if his client is a drug attack.