The Investigation of
The Death of Joan Ellis
August 2009 Drew Memorial Hospital
Joan Ellis complains of
It has been 5 months since Joan was at the Emergency Room at Drew Memorial. When she was last discharged they claimed Joan had an enlarged heart, valvular heart disease, possible coronary artery disease and no heart attacks. They also claimed Joan had issues with her colon but the autopsy does not show that either. Now they claim Joan has had vein stripping, vein stones, thoracic and lumbar spine endplate and facet changes but this is not documented on her autopsy either.
Drew Memorial Hospital
August 2009 Medical Records
2009_Aug_20_Picked_Up_Sept_15_2017_DrewMemorialHospital.pdfPage 1 - EKG : Sinus Rhythm is normal, ECG is normal
Page 5 Chief Complain: Abdominal Pain, Palpatations Tightness, Belching, Flatulance, No energy
Context: Since gallbladder out in March nothing but GI Problems, Last couple of days intolerable, ab jumping, irregular heartbeat, feels bad all over. Tired, took Xanax.
Past Hx: Gallbladder, Hypertension
Surgical Hx
Gall Bladder, Left Endarterectomy, Appendectomy, Cholecystectomy
Vein Stripping - Family and Friends are not aware of Joan ever having vein stripping.
C-section not listed
Family History: CAD, CA (cancer prostate)
Page 6 Clinical Impression: Abdominal Pain, Bile Acid, Diarrhea, Palpatations
Skin: No Rash
Abdomen: Abnml Bowel Sounds increased
Page 9 Triage: Went to MD this am. Increase abdominal discomfort, diarrhea, feeling extra heart beat
Past Medical Hx: HTN, GB, Throat, Tubal, Appendix, Thyroid, Vein Stripping *
CVS: Regular Heart Rate and Rhythm, Skin is dry
Abdomen: Bowel sounds normal
Extremities: no pedal edema
Page 10 - Discharge Vitals: Blood Pressure 122/69 Heart Rate: 82
Page 11
LAB RESULTS FOR JOAN ARE NOT INDICATIVE OF LIVER DISEASE
Joan Ellis Lab Work: Bun, Crea, her Albumin, and her Bilirubin results are normal.
All of which should have returned an abnormal reading is she had liver disease.
Lab Results:
ALT (SPGT) = 51 H
ALP = 144 H
AST = 26 Normal
TBIL = 0.4 Normal
ALB = 3.4 Normal
BUN = 14 Normal
CREA = 0.09 Normal
ACCORDING TO THESE LABS JOAN DOES NOT HAVE LIVER or KIDNEY DISEASE
What conditions other than liver problems can cause increased ALP?
ALP blood levels can be greatly increased, for example, in cases where one or more bile ducts are blocked. This can occur as a result of inflammation of the gallbladder (cholecystitis) or gallstones. Smaller increases of blood ALP are seen in liver cancer and cirrhosis, with use of drugs toxic to the liver, and in hepatitis.
There are other commonly used liver tests that measure other enzymes found in liver cells, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
What conditions other than liver problems can cause increased ALT?
ALT is more specific for the liver than AST and so is much less affected by conditions affecting other parts of the body. Nevertheless, injury to organs other than the liver, such as the heart and skeletal muscle, can cause elevations of ALT. For example, small increases may be seen with skeletal muscle damage or heart attacks.
Aspartate aminotransferase (AST) is an enzyme found in cells throughout the body but mostly in the heart and liver and, to a lesser extent, in the kidneys and muscles. In healthy individuals, levels of AST in the blood are low. When liver or muscle cells are injured, they release AST into the blood. This makes AST a useful test for detecting or monitoring liver damage.
The liver is a vital organ located in the upper right-hand side of the abdominal area just beneath the rib cage. It is involved in many important functions in the body. The liver helps to process the body's nutrients, manufactures bile to help digest fats, produces many important proteins such as blood clotting factors, and breaks down potentially toxic substances into harmless ones that the body can use or excrete.
A number of conditions can cause injury to liver cells and may cause increases in AST. The test is most useful in detecting liver damage due to hepatitis, drugs toxic to the liver, cirrhosis, or alcoholism. AST, however, is not specific for the liver and may be increased in conditions affecting other parts of the body.
An AST test is often performed along with an alanine aminotransferase (ALT) test. Both are enzymes found in the liver that become elevated in the blood when the liver is damaged. A calculated AST/ALT ratio is useful for differentiating between different causes of liver injury and in recognizing when the increased levels may be coming from another source, such as heart or muscle injury
What conditions other than liver problems can cause increased AST?
Conditions that affect other organs, such as the heart and skeletal muscle, can cause elevations of AST. Mild to moderate increases may be seen with vigorous exercise and skeletal muscle injury or in conditions such as acute pancreatitis and heart attacks.
Bilirubin, (TBIL) a substance produced by the breakdown of red blood cells and removed from the body by the liver, may also be performed. Sometimes these tests (along with albumin and total protein testing) are run together as a liver panel. Other tests that may be performed individually or as part of a liver panel to detect or monitor liver disease include gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), and prothrombin time(PT)
BUN is part of both the BMP and CMP, groups of tests that are widely used:
As part of a routine health checkup To check how the kidneys are functioning before starting to take certain drug therapies When an acutely ill person comes to the emergency room and/or is admitted to the hospital During a hospital stay BUN is often ordered with creatinine or renal panel when kidney problems are suspected. Some signs and symptoms of kidney dysfunction include:
Fatigue, lack of concentration, poor appetite, or trouble sleeping Swelling or puffiness (edema), particularly around the eyes or in the face, wrists, abdomen, thighs, or ankles
Urine that is foamy, bloody, or coffee-colored A decrease in the amount of urine
Problems urinating, such as a burning feeling or abnormal discharge during urination, or a change in the frequency of urination, especially at night Mid-back pain (flank), below the ribs, near where the kidneys are located
High blood pressure BUN also may be ordered at regular intervals:
1. to monitor kidney function in those with chronic diseases or conditions such as diabetes, congestive heart failure, and myocardial infarction (heart attack)
2. to monitor kidney function and treatment in people with known kidney disease prior to and during certain drug treatments
3. to monitor kidney function along with a creatinine (CREA) when a CT scan is planned
4. to monitor the effectiveness of dialysis
Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. Creatinine is removed from the body by the kidneys, which filter almost all of it from the blood and release it into the urine. This test measures the amount of creatinine in the blood and/or urine.
Creatine is part of the cycle that produces energy needed to contract muscles. Both creatine and creatinine are produced by the body at a relatively constant rate. Since almost all creatinine is filtered from the blood by the kidneys and released into the urine, blood levels are usually a good indicator of how well the kidneys are working. The quantity produced depends on the size of the person and their muscle mass. For this reason, creatinine concentrations will be slightly higher in men than in women and children.
Results from a blood creatinine test may be used in combination with results from other tests, such as a 24-hour urine creatinine test, to perform calculations that are used to evaluate kidney function.
What does the test result mean?
Increased creatinine levels in the blood suggest kidney disease or other conditions that affect kidney function. These can include:
Damage to or swelling of blood vessels in the kidneys (glomerulonephritis) caused by, for example, infection or autoimmune diseases
Bacterial infection of the kidneys (pyelonephritis)
Death of cells in the kidneys' small tubes (acute tubular necrosis) caused by, for example, drugs or toxins
Prostate disease, kidney stone, or other causes of urinary tract obstruction
Reduced blood flow to the kidney due to shock, dehydration, congestive heart failure, atherosclerosis, or complications of diabetes
Low blood levels of creatinine are not common, but they are also not usually a cause for concern.
They can be seen with conditions that result in decreased muscle mass.
Levels of 24-hour urine creatinine are evaluated with blood levels as part of a creatinine clearance test.
Single, random urine creatinine levels have no standard reference ranges. They are usually used with other tests to reference levels of other substances measured in the urine. Some examples include the urine albumin test and urine albumin/creatinine ratio and the urine protein test.
Page 12 - Why are they prescribing Joan Celexa ?
This medicine (literature below) states if you have a heart condition you should not take this med and even if you don't have a heart condition it can create symptoms of a heart condition.
Joans' lab work in this record indicates she does not have liver, kidney or heart disease. Question: Why did they prescribe Joan Celexa which is an antidepressant? She was not complaining of being depressed. The precautions and side effects of Celexa are Hyponatremia and Prolonged QT / irregular heart beats as well as other side effects that Joan has already reported and seeking medical attention. Her next visit she is now exhibiting these very two side effectsand then they move forward with the claim Joan now has a heart condition !!!!
After Joan is prescribed Celexa ( literature below ) Joan then develops
- Hyponatremia see July 2010 records page 6
- Prolonged QT see October 2010 records page 22
The Drug Celexa is use to treat depression and Joan has not mentioned she is depressed. The side effects of this drug include the very symptoms that Joan has expressed
Side Effects: Nausea, dry mouth, loss of appetite, tiredness, drowsiness, sweating, blurred vision, and yawning
PRECAUTIONS:
Before using citalopram, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, recent heart attack, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).
Citalopram (Celexa) may cause a condition that affects the heart rhythm (QT prolongation).
QT prolongation can cause serious (rarely fatal) fast / irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using citalopram, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, recent heart attack, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).
Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using citalopram safely.
This drug may make you drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Older adults may be more sensitive to the side effects of this drug, especially bleeding, loss of coordination, and QT prolongation (see above). They may also be more likely to develop a type of salt imbalance (hyponatremia), especially if they are also taking "water pills" (diuretics).
are symptoms of a reaction to aspirin.
Joans' Symptoms and Complaints 2008 - 2017
Nasal Polyps - Loss of Sense of Smell - Abdominal Pain - Rash / Hives - Itching - Prolonged Bleeding - Chest Pain - High PT Test - Fatigue - Sweating - Palpitations - Angina / Tightness in the Chest - Edema / Swelling - Headache - Seizures - Weakness - Dizzy - Shortness of Breath - Belching / Flatuance - Vomiting - Hyponatremia - Epigastric - Nausea - Diarrhea - Wheezing - Joint Pain - Anxiety - Low Blood Pressure - Trachcardia - Skin Flushing, Chronic idiopathic urticaria, Spikes in Blood Pressure
CONTINUE ...