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Murray Trial - October 13 - Day 12 - Discussion

Soundmind said:
is it me or the doctor yesterday mentioned the lack of sunlight as a huge factor in causing insomnia he was talking about ICU patients , but no one stressed that fact ,how much vitiligo played role in MJ's insomnia, It would have been great to do that instead of talking about drug withdrawal and anxiety , the expert is downplaying the problem talking about 'secondary' issues .
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I think what he was saying was that in ICU due to lack of windows there's not much sunlight and some patients brain might have problems in deciphering whether its day or night and that can then have a negative impact on their sleeping habits.
 
Ramona122003 said:
Now you're admitted it was long-term after you played with the drug withdrawal angle? Dammit defense, make up your mind.
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Right? I was saying the same thing. First he suggests that withdrawal from demerol caused the insomnia, and then later he is trying to say since 06 other doctors treated Michael for it. Although he is bringing that up to ask the dr, if prescribing a medication without finding out the underlying causes is outside standard care.
 
Good lord Fran, this article already been torn apart from the last witness. What, are you looking from a different response?
 
How does Flan know what type of insomnia Michael had when Murray didn't bother to find out, doesn't appear to have taken a detailed history of him.
 
Ramona122003 said:
Good lord Fran, this article already been torn apart from the last witness. What, are you looking from a different response?
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Maybe he just likes to be whipped and beaten...perhaps he gets off on it? That's why he's going for round 2.
 
Soundmind said:
is it me or the doctor yesterday mentioned the lack of sunlight as a huge factor in causing insomnia he was talking about ICU patients , but no one stressed that fact ,how much vitiligo played role in MJ's insomnia, It would have been great to do that instead of talking about drug withdrawal and anxiety , the expert is downplaying the problem talking about 'secondary' issues .
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The problem with ICU patients is that often times there are no windows (or just very small windows) in the room they're treated in. Therefore they can't actually see sunrising/setting and their bodies can't maintain the regular cycle of waking-up and going to sleep. So I don't think their situation is comparable with that of Michael's.

That's how I understood it anyway.
 
Petrarose said:
Right? I was saying the same thing. First he suggests that withdrawal from demerol caused the insomnia, and then later he is trying to say since 06 other doctors treated Michael for it. Although he is bringing that up to ask the dr, if prescribing a medication without finding out the underlying causes is outside standard care.
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I don't think Flanagan is going for a precise reason. He's just trying to get as many reasons on the record as he can to confuse the jury. If some of them want to believe it was demerol and some want to think it was a history of insomnia for whatever other reason, that's enuf to split their opinions on the matter.

Nader did a great job by not entertaining Flannie's questions about lorazepam and propofol from the pharmacology standpoint. He ended all those "What if" hypotheticals. But he's a lil iffy in spots. Overall, he's doing great. Steinberg is hard witness to follow, tho; much stronger.
 
Laura.L. said:
The problem with ICU patients is that often times there are no windows (or just very small windows) in the room they're treated in. Therefore they can't actually see sunrising/setting and their bodies can't maintain the regular cycle of waking-up and going to sleep. So I don't think their situation is comparable with that of Michael's. Right?

That's how I understood it anyway.
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Actually the lack of sunlight, Vitamin D, can lead to insomnia and even depression. That's why the elderly and some people become depress during the winter when there is less daylight.
 
From TMZ

"After Kamangar, the prosecution is down to their last witness ... The final prosecution witness is Propofol expert, Dr. Steven Shafer "

okkkk... TMZ have been saying for days that Orlando Martinez (LAPD) will testify as well and have called him a star witness, so Martinez wont be testify??
 
Flanagan should stop to rend the air with his idiotic phrases coming from weak-mindedness suffering person.
I cant understand what is he trying to prove here? as far as i know MJ didnt use demerol and used lorazepam time to time when he needed it hard to make himself sleep. aslo CM took MJ's juice to him. what could stop him to put some drungs in there? nobody look over him.
 
dr says he cant discuss blood levels. its above his expertise.. the combination of dip and loraz that is no montiored that is lethal. flanagan keeps asking about the blood levels. dr keeps saying its above my expertise.flangans pushing him to answer again and again.dr keeps saying a pharmocological witness should answer such questions.

one can potentiate the other. ie dip and loraz. ie giving them together can cause a worse effect than giving just one.

flanagan still pushing. drs says above my expertise.

who much dip to get to 2.6 alot of his has to do with when the blood etc was drawn theres a study of ppl who self administerd and the levels were in a range 1.3-6 theres loads of varibles and your questions are hypothetical so i cant answer

flanagan going on about the loraz IV timings 2-5am would you determine whether or not that causes a rise in the 1.6 level in the femoral blood? dr doesnt know above his expertise and practice. flannagans basically implying hes stupid not to know


arnie klien records. dr looked at them april may and june. did you see 6500mg of demoral given to mj. everytime mj got demoral he got midaz did mj had a demoral problem based on the records? he cant asnswer based on the records u cant determine that just by looking at records. botox injection he got midazolam objection substained.

midaz is used for light sedation on procedures. 200mg dem a large dose? yes dr tries not to use demoral as theres better alternatives. demoral can make ppl hyper, excitible. flanagans saying demoral causes insomnia. yes it can says the dr thats a secondary insomnia

did mj have problems with insomnia based on the records? yes he did. what type of insomnia? he doesnt know as murray never did any paper work and im not mjs dr. it seemed there were issues that could cause secondary insomnia anxity/possible dependency based on the paper work . there were suggestions on what mjs insomnia was but nothing else. he based this on murrays police interview i cant make a determination becasue it was based off suggestions. i wasnt his dr

did he he have refectory ? insomnia? no the dr doesnt think he did. dr mentioned it in his report casue murrays care was so out of the ordinary

if u eliminate all secondary insomnia issues then it could be primary insomina and if nothing works for primary insomnia then its refectory? dr says no .its far more techniqual than that. 2006/07 -08 records. did the dr read them? you saw mj tried other drugs for sleep issues. the insomnia was around long before 2009? yes becasue he saw the meds he was been given which were sleep meds

mentions metzger adams klien. dr doesnt know of adams (flanagan trying to throw adams in there) would it beyond good care after 4 weeks of insomnia you start giving meds? talks about the sleep diary etc etc. you need to look at everything in their life taking caffine. theres many factors.

have u ever had a paitent that you thought was being upfront with their history.? yes he has and i try to get other records from other drs. paitent signs a release if the paitent doesnt sign the release you dont the info.correct. what do you do then? talk to ppl who know the paitent get details about what time do they go to bed etc etc ask a spouse. we do the sleep diary and sleep log before anything else. do that for 2-3 weeks. see what their sleep cycle is like. before you prescibe any meds you do sleep diarys try to get background info etc. wouldnt just give medications out straight away. it would be a minor devations to give drugs without doing a proper workup.so its ok to give drugs without doing a work up? no it wouldnt be. your dr should do all the history first.

if the secondary course was an addcition to narcotics the paitent would tell you? objection substained

urine problems cause insomnia. would you do a prostrate exam? not really its common i would ask them first. thats whats important you check thier history

would you check for needle marks? i would see them when doing it. i would document it
taking demoral intermusclule can u see the scares? it depends. some paitents you can some you cant.

mj was getting demoral from time to time sometimes as much as 3 times a week. should murray have know? yes he should have. cause of mjs history and talking to ppl who saw mj with slurred speech etc etc. heshould have asked ppl who saw mj change after been at kliens who would those witnesses be? they would be his drivers security etc. murray should have asked security? yes he should who ever it took the security the assistant? was that a deveation of care? murray not talking to ppl who saw any changes thats murrays fault he knows who was with mj

you had a paitent who wasnt been upfront and he was with someone else would you go ask that person? ie a wife yes i would ask the paitent if i could talk to the wife if the paitent said no. then i wouldnt talk.

would you talk to the driver of mjs car ? yes i would. has that occured with you in your practice. no it hasnt. (i doubt most of his paitents have bodyguards!)

do you believe that mj didnt have refectory insomnia.? i dont have enough info and history to know. any secondary issues were not written down by murray

disturbing unethical for diprivan to be used for insomnia. flangan bringing up a study on dip being used. the dr says its experiments and basic studies its not a standard of care bringing up the chinese report.. saying u can use the report to treat insomnia does the dr know of it ? yes he does. its from 2010. it was used over 6 months after extensive history was done. no secondary conditions. it was done with full medical equipment. they fasted b4 they got informed constent. they were highly monitored and had a infusion pump used.

flanagan says the case study worked after being give diprivan. and there were no problems. dr says there were no complications cause it was done in a hos they were monitored and had infusion pumps

flanagan says diprivan can work for insomnia. dr says it was a a basic study and even those who carried out the study says you need a lot more work before it could ever be used for insomnia

flanagan says they got good result. yes but it was an experiment. it wasnt a large random trial. dr who did the trial said more studies were needed. if we have a monitored setting dip can be used for insomnia? the dr says theres not alot of info at all to make a decision on that. flanagans saying its not incomprehensible to give diprivan for insomnia cause they had a study in china. dr says is everything ontop of giving diprivan ie outside of a hopsital no equipment. we dont use diprivan in a hospital for insomnia let alone anywhere else

flanagan saying u give ppl dip in the hos to sedate them thats sleep isnt it? dr says heck no. the treatment is given to ppl who are on mechanical ventilation who have a breathing tube. diprivan is given to make them comfortable cause of the tubing its used to sedate them.

what amounts do you give in the hos? (sorry didnt get it). its given by infusion pump monitored etc. dose for intubate depends around 1.5-2 mg per KG if they are a normal healthy paitent.every paitent is different.depends on their issues. like if they already have low B.P or if they are old. slow push 2mg every 10 seconds normally over 2 minutes. maintance dose is given by a programed drip.

what the lowest dose u gave? 15 mg is the answer. so murray gave 25mg. thats a low dose? yes it is. you wouldnt expect that to cause complications.answer not nescessarily. but it depends on issues. ie if mj had low B.P and ontop of the sedatives mj was given then all bets are off that is enough to tip u over the edge

but if murray didnt know about the other drugs then 25mg would be safe? dr wants more details. thats an open question flanagan gives more details objection substained. flanagans grasping at straws with hypothetical questions
 
lorazepam can be used in oral form in specific settings
 
Actually the lack of sunlight, Vitamin D, can lead to insomnia and even depression. That's why the elderly and some people become depress during the winter when there is less daylight.
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Exactly that's what I'm talking about, he talked about a material in the brain that requires the sunlight to be produced and gave an example the patients in the ICU . So I believe the same applies to someone who had vitiligo and how lack of sunlight could have affected his ability to sleep
 
loraz in IV form. PDR says you can use it for insomnia. dr says the FDA dont list it as treatement, loraz in tablet form can be used but the FDA dont approve of it.


dinner break for me if someone can post updates for abit
 
Dr K: would consider lorazepan in oral form in addition with looking at underlying problem and addressing that, also would only use it for a very short time.

15 min break
 
Nice Flan, keep hammering in to the jury how additive lopz is and how stupid it was for Murray to even considered that drug as well on top of the propofol. The DA didn't even have to bring up this point and you did it all so willingly.

This guy loves digging holes for himself.
 
Thank you, Nader!! You would not cancel an event that was causing the anxiety. YOu would try to find TREATMENT for the anxiety in a way that's beneficial to the patient.

I think that's an important statement some folks need to hear and understand. Cancelling the shows was not going to make the problem go away. In fact it could have made the problem worse.

This is MURRAY's cockup!
 
Ramona122003 said:
Nice Flan, keep hammering in to the jury how additive lopz is and how stupid it was for Murray to even considered that drug as well on top of the propofol. The DA didn't even have to bring up this point and you did it all so willingly.

This guy loves digging holes for himself.
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Sometimes, he makes you think he's secretly changed sides and now works for the pros.
 
wendy2004 said:
Thank you, Nader!! You would not cancel an event that was causing the anxiety. YOu would try to find TREATMENT for the anxiety in a way that's beneficial to the patient.

I think that's an important statement some folks need to hear and understand. Cancelling the shows was not going to make the problem go away. In fact it could have made the problem worse.

This is MURRAY's cockup!
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Yeah Wendy, I'm so glad that Dr. Kamanager said that!
 
thank you elusive, volitional, ivy and everybody else who posted updates and commentaries. You're my heroes.

I like this doctor. He's polite yet firm. But Steinberg was the best.
 
gerryevans said:
Sometimes, he makes you think he's secretly changed sides and now works for the pros.
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Strangely, I thought that too. He gave many opportunities for the witness to say "egregious deviation from standard of care." Not sure why he didn't just keep the cross SHORT? Badgering a witness doesn't usually play well with a jury? I really don't see much defense LEFT now? The last two witnesses were GREAT!
 
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Actually the lack of sunlight, Vitamin D, can lead to insomnia and even depression. That's why the elderly and some people become depress during the winter when there is less daylight.
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thats why theres millions of ppl in the uk on anti depressents!! seasonal effective disorder.

i doubt the TMZ article about shafer being the last witness is correct as there is no court tom because of a witness scheduling issue. so unless thats shaffer who cant testify tomorrow if it doesnt get finished today that means theres more witnesses.if it were shafer the judge would make a ruling on there being no court tom if shafer was still on the stand by the end of the day

anyway so much for demoral not being allowed to be brought up
 
he also stated something of great importance at the beginning of today's testimony responding to Flanagns's statements on MJ resistance to Murray's treatement "the patient HAS THE RIGHT TO REFUSE YOUR TREATEMENT and you have to try and find why he REFUSED, because he had a reason to refuse , what was that reason?!! ".

It would have been wonderful if he told him at that time MJ had VALID REASONS to say no to the lorazepam freaking treatment Murray was offering. Hopefully Walgren will stress this point during re direct.

yeah what's up with the demerol talking? watch Walgren asks the expert to stress even if he was addicted and abusing demerol Murray had to know what he was doing behind his back !!!!

Bring those demerol records and tell the jurors the slurred speech was due to Murray's freaking treatment.
 
Doesn't matter if they mentioned demoral. Flan bring that up made Murray look even more incompetent because he didn't ask about the patient's history and just took Michael at his word supposedly. As the witness pointed out, he should had asked everyone around Michael about his history if he refused to show his medical files. The fact that Murray admitted on tape that he didn't really know Michael's doctors, didn't talk to them, and didn't know what they were given him show Murray to be an incompetent doctor.
 
elusive, please holla if you're back :)

In the meantime...

CM didn't specify the level of dehydration in the interview, did he (Flan), no he didn't (wasn't allowed to add something)

25 mg over a long period of time would cause sedation for no longer than 5-10 minutes if no other agents were administered. But he's asking a general question and this is a specific case, plz be more specific when whom you're refferring as he lol
 
Flan confirms that he's referring to MJ.
Would he expect the patient to automatically wake up after the effect of Propofol was gone, yes, he would expect to slowly regain consciousness and wake up.

What if the patient was tired and would sleep, no, if the patient would still sleep after he administered Propofol, he would find it very disturbing. It's an imperative to make sure that the drug is no longer working, it's an obligation of the doctor offering care.
 
25mg of Propofol infused in a 61kg person (Michael), Dr. Kamanager expects that would last 6-10mins.
Expects patient to generally wake up after that amount of time.
 
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