Seacoast Medical Orders by Conrad Murray

This will be another blog in progress, which means it will be updated over time as more information become available as we only have bits and pieces as it stands right now.

I thought it would be a good idea to post up photos of some of the items we know Murray ordered (or attempted to order as some items were on back-order and cancelled) and how they may or may not have pertained to Michael's death--or to just give everyone a general idea of what they may be in this case. This information here will play a part in my next blog where I will be discussing the IV found in the bedroom.

For this blog, I will be covering the items Murray ordered from Seacoast Medical.

Below are copies of *some* of the orders from Seacoast from the trial. Some may be duplicated and some may be missing as well; information regarding dates that is currently known or thought to be known will be provided at the end of this blog:



























For some of the items that are not easily understood, I will briefly explain what they are and provide a photo if available. I was able to trace back to the manufacturer what was exactly what through Seacoast's online product inventory--if you have any questions of how I was able to do this for verification purposes as I do not mind my work being checked, please ask:

#101143 Sodium Chloride Bacteriostatic 0.9%, 30 mL, 25 vials
--this is normal saline (0.9% NaCL or salt), "bacteriostatic" means it contains preservatives and can be used multiple times vs. using a vial only once, this could be used to dilute medications, like IV lorazepam

#002366 Welch Allyn Cuff, etc. and #002672 Aneroid Access
--these are both components to a basic blood pressure cuff, with accessories

#105777 Medex Injection Adapater, etc.
--photo provided below; this adapter is an IV tubing extension--it would connect via Luer Lock and provide for administration via a syringe and needle into IV tubing



#106091 Medex T Connector, etc.
--photos provided below; this is an IV extension kit that has a syringe w/ needle valve (the top port) and a Luer Lock connection as well (bottom port, this would connect to an IV catheter, for example); Murray had one of these, unused, in one of the bags he placed in the closet





#309578 BD 20 G X 1" 3CC Syringe/Needle
--these are 3 mL syringes that come with a 1 inch, 20 gauge needle

#011281 Medex Jelco IV Catheters Radiopaque 24G X 3/4"
--these are IV catheters that are inserted into a vein to administers medications and IV fluids; the larger the gauge of a needle, the smaller the needle actually is (inversely related)

#???483 Syringe 10CC Luer Lock Needle 22G X 1"
--these are 10 mL syringes, with Luer Lock (twist on rather than push or snap on) needles attached, 22 gauge, 1 inch long

#???068 3G Latex Free Glove, Large

#007774 Exel IV Administration Sets, 15 drops/mL, 50 per case
--this is the IV tubing featured below and what was found in the bedroom









#013452 QMS Exam Table Paper
--this sounds like office supplies to me--odd to be ordering it when a doctor is rarely present and his office is ran by non-medical staff

#106176 Avalon Exam Cape Disposable
--appears to be more office supplies

#105884 QMS Exam Gloves Vinyl, Medium

#105883 QMS Exam Gloves Vinyl, Small

#105841 Dukal Alcohol Prep Pads
--these are like the alcohol pads used before you insert a needle into the body

#009737 Starline Gauze Sponge 4" X 4"

#011611 2-Ply Fanfold Drape Sheet
--again, appears to be more office supplies

#798302 Sodium Chloride (IV) 0.9%, 250 mL bag, 48 bags ordered
--these are 250 mL normal saline bags

#798309 Sodium Chloride (IV) 0.9% 1000 mL bag, 24 bags ordered
--these are 1 liter saline bags; apparently Murray ordered some bags from Seacoast and some from Applied Pharmacy Services as well

#007827 Exel Luer Lock Syringes, 10 CC, 100 per box
--these are 10 mL syringes, using Luer Lock, but did not come with accompanying needles

#103483 Syringe 10 CC Luer Lock Needle, 22G X 1", 100 per box
--these apparently go to the syringes mentioned directly above, 22 gauge, 1 inch long

#007853 Exel Hypodermic Needles, 18G X 1 1/2", 100 per box
--these are additional needles, not sure if they are Luer Lock or not, 18 gauge, 1 1/2 inches long

#????85 QMS Exam Gloves Vinyl, Large

#102902 Blood Pressure Device, Child
--this is a child's blood pressure cuff; adult cuffs were ordered as well

#103293 3M Transpore, 12 per box, 1" X 10 yards
--this is basic medical tape

#103653 Tourniquets, Latex Free, 10 per bag

#011287 Medex Jelco IV Catheters, Radiopaque 22G X 1", 50 per box
--these are IV catheters that are inserted into a vein to administers medications and IV fluids, these are slightly larger than the 24 G (22 G are blue, 24 G are yellow)





#103747 Starline Prem. Blood Pressure Unit, Black, Latex-Free Adult
--this may be the one that was located in the bedroom, apparently unopened and unused

#??5914 Kendall Tendersorb Underpads
--these are the "chux" pads or padding that was on the bed, for incontinence

#??6613 External Catheter--Medium (Condom Catheter) and #004241 Tegaderm Transparent Dressing, 2 3/8 inch X 2 3/4 inch
--photo provided below (these would not be used together, to save time I included them together in the photo; the Tegaderm dressing could be used to help keep IV catheters in place



#??6653 External Catheter, Small, 30 per box

#??4839 Leg Bags for Catheters, Medium, 12" extension tubing, 17 oz.

#???466 Ambu-Bag w/ Adult Mask, 1 ordered
--photo provided below; apparently Murray had this very important piece of equipment but did not care to use it as he used mouth-to-mouth resuscitation instead--an ambu-bag, oxygen or not, is a better method



#????66 Berman Airway 6, Single-Use Kit
--photo provided below; these are disposable airway kits, only 2 were ordered and apparently no such set was at the house on June 25th; commonsense should tell anyone that if you are thinking you need something like this for a regimen for sleep, then something is wrong



#309650 BD Syringes, 30CC, 40 syringes
--these are 30 mL syringes, no needles provided

#005667 Chester Ultrasound Gel, 5 Liters w/ 8 ounce bottle
--given Murray is a cardiologist, this gel would be used to do echocardiograms in the office; an echo tech may do the echo (this requires training) but a doctor needs to review the echo to determine if there is a problem or not

#103568 Cardiosens Electrodes Disposable Ultra II Tabs, 500 per box
--photo provided below; these are the pads that connect to wiring which connects to an EKG machine--something Murray obviously had at his disposal but failed to use to keep Michael alive (though again, if you are needing something like this to treat insomnia, something is wrong)



#009729 Starline Brand Gauze, 2" X 2"

Oddly enough, Murray claims in the LAPD interview that he kept those 3 bags found by Fleak regularly at the house, and in the closet per Michael's request. Though he had plenty of medications, used and unused--he apparently did not have spare condom catheters, spare IV tubing, more normal saline bags for rehydration, etc. I also wonder--where was some of the trash? Where are the syringes that were used to administer midazolam and lorazepam? Where is the old IV tubing, where are the old IV catheters, where were used needles? Why were only vials of medications kept by Murray? Did the LAPD examine any trash in the home, did Murray or others take any items as they left the house? What about the fireplace in the master bedroom--did Murray have access to this room and is there any evidence anything was burned in the fireplace?



Now, I missed this critical testimony myself but thanks to my "research family" I was able to get some information about these orders though it needs to be thoroughly reviewed when transcripts are made available to the public. Most videos on YouTube have cut a majority of critical testimony that was shown on TV. If you can add any information to the information below, please do.

Murray had apparently opened an account with Seacoast in 2006. He ordered some lidocaine through the company and he had possibly ordered pumps AND/OR IV pump tubing usually used with pumps in July 2007, October 5th 2007, June 24th 2008 and then attempted to request Safsite IV tubing March 25th but it was not in stock. He attempted to order it via the manufacturer but his credit card was denied.

This is the image of what I believe he attempted to order on March 25th (#105778 SAFESITE HORIZON PUMP IV SET 24/CASE, Manufacturer #SS3140 via B Braun Medical) , though there is a mismatching of the names of this product--I matched the manufacturer numbers to come up with this:



Possible Order Dates:
April 14th (3 pages)
May 12th--Exel IV sets purchased (notice this is after the May 10th recording though who knows what Murray really had collected overtime)
May 19th
June 1st (this order included the ambu-bag and 2 airway kits)
June 15th--talks with Connie Ng about urine catheter supplies, she attempted to order but not available (Connie Ng inquired with Seacoast for all purchases)
June 17th--follow-up conversation, but out of stock
June 22nd--invoice for catheters, small, shipped that day, leg bags not shipped (however a wrapper with medium sized catheters was found at the house and apparently some bag was used)
June 26th--at 9:26 a.m. PST Connie Ng cancelled back orders and asked for a refund

Seacoast would not allow items to be shipped to a house in California--items had to be shipped to the office in Las Vegas (this was attempted on April 13th only)

I realize there is some confusion regarding the condom catheters so if someone can add more information, please do.

QUESTIONS:

Had Murray ever actually ordered an IV pump or was it just IV tubing typically used in a pump? WHY? To the best of my knowledge a cardiologist does not need tubing or especially an IV pump in their office. Did he order any lidocaine while treating Michael? I never saw any on the invoices. He did order some medium-sized condom caths--when? I saw the order for small condom caths and medium bags as well--so out of this, what all did Murray get and not get and when?

Again, this blog will morph over time and/or be added to as time progresses as more information is obtained or understood so stay tuned.

Is Propofol Safe for Sleep?

Is propofol safe for sleep? Simply put, the answer is no. However, there is a study that was published online in November 2010 entitled "Propofol-Induced Sleep: Efficacy and Safety in Patients with Refractory Chronic Primary Insomnia".

Here is a link to the study so you can read it yourself and I urge everyone to read it carefully as it does contain some great insight into insomnia and how it is conventionally treated (and how many conventional treatments fail):

http://www.springerlink.com/content/q1383124j665v845/fulltext.pdf

The study was done in China on patients who were considered to have "refractory chronic primary insomnia". This means these patients do not have any underlying causes for their insomnia (ex. sleep apnea or bad habits), they have it continuously and conventional treatments have failed them. A friend of mine who is a nurse told me there is no listing for "refractory chronic primary insomnia" in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) so I am not sure if people can be diagnosed as having such or if this type of insomnia was coined specifically for this study. Regardless, the study states 30-40% of adults suffer from insomnia and that is a considerable sum of people who suffer from this ailment.

For the clinical trial there were 103 participants--64 received propofol and 39 received saline. I am not sure how much (milligrams) each patient received but the study states the 64 who received propofol received propofol at a concentration of 3 g/L. This seems to indicate propofol was diluted as it is typically in a concentration of 10 mg/mL which is also equal to 10 g/L. The study states, concerning administration, "the protocol for propofol administration was based on our earlier study according to some clinical parameters such as age, weight, liver function, renal function, etc." I have not been able to locate this study yet (the name is included in the study as a source) and have attempted to email the professor who did this study to see just exactly how much propofol was received by these patients as I am very curious to know. Anyhow, those who received propofol received a 2 hour infusion at rate based on the guidelines from a previous study, starting at 10:00 pm each night, for 5 nights.

The patients had their brainwaves monitored and also filled out questionnaires that were used to determine if the propofol had made any improvements in sleep on the first morning after the last treatment and 6 months later as well.

According to the questionnaire that patients took part in, those who received propofol were more likely to report improvements in how long it took them to fall asleep, their quality of sleep, their ability to wake up after sleeping and what waking up in a better mood. These improvements were still evident 6 months later as well. Individuals who received propofol also reported longer sleep times, faster times at falling asleep and fewer awakenings during the night.

There are four stages of non-REM (NREM) sleep and then there is REM sleep, which is the deepest state of sleep and the most restorative. According to this study, Stage I NREM was shortened with propofol, Stage II NREM was unchanged, and there was an increase in NREM Stage III, IV sleep as well as REM sleep. Stage I NREM is the lightest level of sleep while Stage IV is heavier.

For those who received propofol, there were few reported adverse events. Four said they experienced somnolence during the morning after treatment, two reported being dizzy and two had mild nausea. There were no reported issues 6 months later.

The researchers who conducted this study state they believe that propofol may be able to restore sleep homeostatis after sleep deprivation. This would seem likely given positive results even 6 months later.

The study closes with the following paragraph:

Future studies on the efficacy and safety of propofol induced
insomnia should be aimed at confirming these findings in a multi-center cohort study. Since our study participants did not suffer from an ongoing psychiatric or medical condition, it would be useful to know whether propofol-induced sleep would be therapeutically beneficial in such patients who also suffer from insomnia. Lastly, the results of this study also calls for further investigation on the mechanism of propofol action on the attenuation of the sleep debt in patients with refractory chronic primary insomnia.

The article also mentions that they believe they are the first to demonstrate propofol-induced sleep is a safe and effective alternative treatment for patients with this kind of insomnia.

Now--with all that being said, I think it is important to distinguish how this study does NOT relate to anything Conrad Murray did to Michael Jackson.

1. This study was the first of its kind--this means there were NO studies for Conrad Murray to base his "treatment" on for Michael. This study was published almost 18 months after Michael was killed. Murray is not an anesthesiologist, neurologist or a sleep specialist. He is nothing as far as I am concerned.

2. Though we do not know exactly what Murray did to Michael as far as what all he administered, how he administered it and when he administered it, in this particular study propofol was only used for 5 days from 10:00 p.m. until midnight. That is a total of 10 hours of propofol use for the entire treatment. Whatever Murray was doing lasted far more than 10 hours and Michael was obviously having adverse effects that were lingering into his rehearsals.

3. This clinical study took place in a clinic--not a home setting.

4. Propofol was administered continuously with a micro-infusion pump--not a gravity-drip device with a roller clamp, as Murray had ordered supposedly for rehydration.

5. Blood pressure was continuously monitored.

6. An EKG, or the heart rhythm, was constantly monitored.

7. Oxygen saturation was constantly monitored.

We can gather from this study that someday, with more research, propofol may be useful to those who are healthy and have insomnia that is not successfully treated with conventional methods. Does this mean that Murray was right in what he did? No. Does it mean propofol can now safely be used for insomnia? No. Does it mean it will ever be safe to use for insomnia? No. There is too much that needs to be learned before such a leap is made. There are still no excuses for what Murray did and absolutely no justification in his actions, be it administering propofol or simply refusing to administer appropriate aid to his patient. Murray's actions continue to baffle even the most seasoned of medical professionals. No one can put a direct finger on what exactly he did to Michael--but as Dr. Alon Steinburg said today in court--Michael Jackson was savable. He should have been saved but for whatever reasons, he was allowed to die. Many of you reading this hurt from Michael's death and though we may see Murray found guilty there is still a huge knife in our hearts because we do not know why he had to die or how he died. Yes, we have a cause of death but we do not know how it came about and that for me is painful, especially knowing that the man who sits in court everyday looking like a clown yet not shedding a tear (except for the first day when the discussion was focusing on him) knows what happened and why but is not talking and will never talk if he has it his way. Well, he will talk but it will not be the truth.

The following articles remind us of why propofol is not currently used for sleep and why it would never be used for sleep in a home-setting:

http://sciencelife.uchospitals.edu/2009/07/31/propofol-a-dangerous-kind-of-rest/

Though the following study does not promote or detest the use of anesthetics for sleep it is a fascinating read that discusses how general anesthesia is basically synthetic brain-stem death rather than sleep:

http://isafars.org/uploads/anjoman/General%20Anesthesia%20NEJM%202010.pdf

We can gather in the propofol for insomnia study that propofol was not used like it is for general anesthesia--a key indication of this is the lack of intubation in those patients who received propofol. However, it is important to remember that there is a fine line between the different stages of sedation (from consciously sedated to general anesthesia), especially when using propofol. Because of that, precautions will always need to be put in place, just in case. As the Boy Scout motto says--"be prepared".

Lorazepam

I want to rehash some basic information that toxicologist Dan Anderson provided during his testimony last week about lorazepam. Though he stated he could not determine whether or not the elevated blood level of lorazepam was from oral or IV administration, he was clear in stating there were no tablets in the stomach and the level of lorazepam was high, but not toxic. The defense's argument that Michael took eight 2 mg tablets of lorazepam then quickly gave himself propofol and then died... instantly... actually died instantly with Anderson's testimony. That is the point I want to bring home in this blog.

First, here is some numbers for lorazepam (Ativan) for oral vs. intramuscular (IM) vs. intravenous (IV) administration:

Oral: onset of action--~30 minutes; time to peak (drug concentration)--~ 2 hours
Intramuscular: onset of action--~20-30 minutes; time to peak (drug concentration)--~1-3 hours
Intravenous: onset of action--~5-20 minutes; time to peak (drug concentration)--~10-20 minutes


Peak time for amnesic effects for oral is 60 to 90 minutes.
Peak time for amnesic effects for intravenous is 15 to 20 minutes.

The maximum recommended dose for insomnia is 4 mg--ORAL only unless a patient is NPO (nothing by mouth) in the hospital--then IV may be used.

All methods above have effects that last approximately 6-8 hours. Oral lorazepam is slightly less potent than intramuscular and intravenous (90% bioavailablity). Bioavailability of 90% means that an oral dose is roughly 90% as effective as an IM or IV dose. Or, think of it as taking a 1 mg tablet and 0.9 mg of that tablet being "active" lorazepam.

An IV 4-mg dose provides an initial concentration of approximately 70 ng/mL.
An oral 2 mg dose provides an initial concentration of approximately 20 ng/mL.

Michael's blood level was around 160-170 ng/mL. Therapeutic levels are listed as 50-240 ng/mL (most sources state therapeutic can be as low as 10 ng/mL and anything over 300 ng/mL is toxic). As you can see from this data, it is impossible that Michael was given only 2 mg of IV lorazepam twice by Murray, especially not with the last 2 mg dose being at about 5:30 a.m. This blood level does not tell us how the drug was administered but given it takes some time for an oral dose to get distributed into the body (see the times above) it is impossible this blood level was the result of oral administration within minutes of death. There were two 10 mL vials of lorazepam used (these vials were either 20 mg or 40 mg each, depending on the concentration which I do not know at this time but will hopefully know soon). Murray admits to giving IV lorazepam and was there at the house--why would Michael need to take anything oral or even IV with Murray there? There was no reason, to make it simple.

Doses of 8 mg to 10 mg of intravenous lorazepam (2 to 2-1/2 times the maximum recommended dosage) will produce loss of lid reflexes within 15 minutes. I simply found this interesting though it may not relate to this case. However, it tells us how sedated one can become on doses similar to that in Michael's body. Tolerance or not, 10 mg should have had some effect on him, especially if Murray is being honest and said he slept fine the night before on benzodiazepines only. There is no such thing as physical withdrawal of propofol so Murray's claim that the benzodiazepines did not work the next day because of "propofol withdrawal" is fallacious based on the lack of physical withdrawal of propofol and the inability to build a tolerance to benzodiazepines within a day, too. Once again, Murray is lying.

So how did the lorazepam end up in the stomach?

There is a process some drugs undergo called "ion trapping":

http://en.wikipedia.org/wiki/Ion_trapping

Simply put, some drugs that are basic or alkaline (pH greater than 7) tend to go to acidic places in the body. The pH of the stomach is typically around 1-2 which means it is very acidic. Thus, it is natural for some lorazepam to essentially leech from the blood and into the stomach. I like to think of this as "opposites attract"--if something is basic it will look for an acidic environment--if it is acidic it will look for an alkaline or basic environment (ex. the bladder can be an alkaline environment if the urine is basic). Anderson explained this in very simple terms and also explained that given the amount found in the stomach, though four times the amount found in the blood, it amounted to 1/40th of a tablet of lorazepam. This is not equal to oral ingestion of lorazepam tablets.

Below is a snapshot of Anderson's math in which he derived his amount of propofol in the stomach:



There we have it--Michael did not die from the ingestion of lorazepam tablets, be it 1 or 8 tablets. One question that lingers is--where are the syringes used to give lorazepam and midazolam? I have always assumed Murray may have reused the syringes he had and the leftover amount of benzodiazepines were eradicated with reuse of the syringe for propofol administration or too low to detect after reuse. I would also think it is possible he tossed them in the garbage or possibly tossed them in the fireplace that was on in the master bedroom--a fireplace on in late June, mind you. Investigators did not search the house very well or close it off so that leaves the pursuit of justice with a lot of gaping holes.

To tie all this together, propofol begins to work in less than a minute and depending on the dose, wears off in usually less than 15 minutes even for large doses. Regardless of the method of administration, lorazepam takes at least 5 or so minutes, minimum, to begin working. That means the administration of these drugs, if given around the same time, should never be at peaks "together" unless lorazepam is already at a high level (which would likely indicate sedation) when propofol is administered. That would indicate someone other than the person sedated would have to administer propofol for both of these drugs to be at such high levels in the body, with the lorazepam being administered first since it takes longer to become active. For there to be additive effects, which were mentioned in the autopsy report, the lorazepam should have been having an effect on the patient (sedation, possibly breathing problems, etc.). People do not typically die from benzodiazepine overdoses but giving lorazepam with propofol in a setting with no airway or respiratory assistance--you are basically asking for someone to stop breathing and die.

In closing, here is a warning that is quiet visible to anyone who reads about lorazepam:

AIRWAY OBSTRUCTION MAY OCCUR IN HEAVILY SEDATED PATIENTS. INTRAVENOUS LORAZEPAM AT ANY DOSE, WHEN GIVEN EITHER ALONE OR IN COMBINATION WITH OTHER DRUGS ADMINISTERED DURING ANESTHESIA, MAY PRODUCE HEAVY SEDATION; THEREFORE, EQUIPMENT NECESSARY TO MAINTAIN A PATENT AIRWAY AND TO SUPPORT RESPIRATION/VENTILATION SHOULD BE AVAILABLE.

On June 25th, 2009 Conrad Murray had nothing with him to treat airway obstruction in Michael while he anesthetized him as a way to treat insomnia and though Murray had an ambu-bag he refused to use it, opting for mouth-to-mouth, one-handed, in the bed CPR. He did not even have a pulse oximeter on Michael. How could someone entrusted to take care of someone be so damn careless for another person's life?

The IV Bag--Photos

This blog will be a work in progress...

The following photos were taken by Elissa Fleak on June 25th, 2009:





The following is a photo from June 29th, 2009. Fleak also took this photo and stated that LAPD moved the syringe--it was not moved between the time she saw it on June 25th to June 29th.

Conrad Murray's Medical Records for Michael Jackson

11/19/08:
Insomnia/Anxiety
Prescriptions:
Xanax 0.5 mg--Take one tablet by mouth every 6 hours (cut off)
Restoril 30 mg--Take one tablet at bedtime as needed

9/26/08:
Insomnia
Restoril 30 mg (cut off)--no refills

2/1/08:
Cough, nasal congestion, (cut off, but possibly says "chills")
generalize(d) fatigue, all (cut off)
Assessment/Plan: upper respiratory infection/(cut off, possibly "viral")
increase fluids (drink more fluids)




4/12/07:
Onychomycosis (spelling) -- Lami (cut off, but states Lamisil)
for 3 months, check liver function tests after 1st (month)
may take 6 months - 12 months
(Liver function tests are done when taking Lamisil because it has caused fatal
cases of liver failure.)

3/07 (not day given):
"M" -- cough, chills, (cut off)
with intermittent specs of blood (cut off)
Phlegm greenish brown
Pleuritic chest pain with cough (cut off)
lower rib cage
chest x-ray positive for right lower lobe pneumonia













"Omar Arnold", 49 years old
(Notice a date is present on one document and not any of the others though these appear to be the same document, appears to the one date is 1/24/06 but is likely 1/24/08, as he was 49 years old then, however it looks more like a "9" rather than "8" for the year)
Complain of weakness, body aches, persistent cough
with mild yellowish phlegm, ??? fever chills ???
have been fever, ???
children have same symptoms, ???
well. All ???
consuming liquids. No ??? loss of appetite
negative for chest pains

(The middle and lower portion of this document is sadly too blurry for me to make out at this time.)

Assessment:
Dehydration from decreased fluid intake
???
???
??? vitiligo (spelling?)
Plans:
Fluid hydration (cut off)
???
2
Benoquin 20% cream (cut off)
apply twice to ???
Youth Essense
Allergies -





Arnold, Omar (MJJ)
"M"
cough, chills, productive cough with intermittent
specs of blood with deep coughing ???
???, general weakness, pleurtic chest ...
cough worst on right lower rib cage
chest x-ray--positive for right lower lobe pneumonia/???
small ??? of pleural fluid with ???
Plan:
1. Omnicef 600 mg one a day
2. Z-pack
3. Lortab (for pleural pain and cough)





Omar Arnold
1/11/06 (date appears to be incorrect)
Cough, chills, fatigue, (cut off)
??? otherwise (cut off)

(This sheet also states Michael was negative for orthopnea and edema--possible signs of heart failure. This sheet appears to be one that Murray used for his cardiac patients.)




Michael
1. Robitussin AC--1 to 2 teaspoons every 4-6 hours as needed for cough
2. Omnicef 300 mg--Take one by mouth twice a day for 7 days
3. Nasonex--one puff (in each nostril) daily for 5 days, then as needed if sneezing and congested.





Prescription written on 2/10/07:
Youth Essence Moisturizing Cream--SPF 30









11/13/07

Page 1:
...tion of the posterior horn of the medial men...
subluxation of patella, with knee in neutral...
effusion, small Baker cyst with slight leakage...

Page 2:
Fluid without focal erosions or degenerative
...angular fibrocartilage tear or per
...fluid, ??? greater

Michael Jackson Drank Propofol? Not So Fast...

This will probably be my shortest blog ever. The reason I have decided to blog this information is because it is critically important in dismissing the fact, once and for all, that Michael drank propofol. I have been calling this bullocks since day one. I thought it was a joke when I heard the defense had come up with this notion.

There are not many studies out there about "drinking propofol" but certainly, I can tell you based on just basic medical knowledge that propofol being drank could not be lethal or likely even cause an effect (the only hypothesis I can fathom in which there could be sedation to some degree may be if there is some type of ulceration in the stomach which would allow propofol to go directly into the blood from the stomach). Propofol would be "chomped" up by the liver and likely no active drug would ever make it to the brain. All metabolites (propofol broken down by enzymes in the body) are inactive, as in, they cause no effect. Again, the principle of what I am saying is--PROPOFOL DRANK CANNOT KILL.

But, above all this as explained above, and to save people's time rather than bore them to death with medical journal articles, I give you this information:

I learned, first hand, today that 1 MILLIliter of propofol weighs approximately 1.1 GRAMs. The amount of propofol in Michael's stomach was recorded as 0.13 MILLIgrams (NOT in a drug concentration of 0.13 mg/mL). One GRAM equals 1000 MILLIgrams. Using ratios and proportions (math) this would conclude that 0.13 MILLIgrams would be approximately:

(Drum roll please...)

0.00012 MILLIliters (mLs)

That is not an amount likely visible by the naked eye and is hardly an amount that could be orally ingested. I think most people know how much a milliliter is, but for comparison, there are 5 millliters in one TEAspoon. This amount in Michael's stomach is not a tenth, not a hundreth, not a thousandth but a TEN-THOUSANDTH of a MILLIliter.

Let the defense try to worm their way though that one. I dare them...

Oh, and while I am at it, do not forget I already debunked their claim that he self-injected, it, too:

http://gatorgirl277.blogspot.com/2010/08/michael-jackson-did-not-administer.html

I have since added more information annihilating the "self-injection" fantasy, rather than theory, throughout my blog in various posts, such as this one.