Wednesday, April 18, 2012

Survival Secrets...

Want to stay alive? Survival secrets from an expert who REALLY knows

By Dr Jan Garavaglia

As a forensic pathologist, I’ve handled thousands of cases over the past 20 years. Normally, I don’t get emotionally involved; it’s my job to find answers and come up with a cause of death. People are counting on me to keep my emotions out of it.

But one day the body of a ten-year-old boy lay on the stainless steel table before me and I couldn’t help thinking that he would never graduate from university, never buy his own car, never fall in love and he would never have a family of his own - all the dreams I had for my own ten-year-old son.

As it happened, this boy died of a terrible, tragic error. The lab report showed he had a high level of methadone in his blood, enough to kill him.

Windows rolled halfway down cause the most traumatic injuries
Road rules: Car windows rolled halfway down cause the most traumatic injuries

Methadone is a legal drug for weaning addicts off heroin. It’s often used for the management of pain, and its illicit use is a growing problem.

There must be a mistake, we thought. How would a ten-year-old kid get his hands on methadone?
It didn’t make sense, so we repeated the tests.

Again, they came back positive for lethal levels of methadone. We talked to the boy’s mother. What we discovered was that he was being treated with another drug, methylphenidate. For several days prior to his death, he had been feeling uncharacteristically groggy and sleepy. Concerned, his mother notified the doctor, who suggested cutting the pills in half.

She did so, but his lethargy continued until the time he was found dead in bed. We tested those pills and discovered they were not methylphenidate at all. They were methadone.

The two drugs are very close alphabetically and the unthinkable had occurred: a pharmacy error. My heart went out to this mother, who was doing everything right to help her son but in the end was failed by a sometimes imperfect health-care system.

Sadly, this is not an isolated occurrence. Pharmacies do slip up. Some slip-ups, like a misspelled address, for example, won’t hurt anyone, but many other errors could cause serious discomfort, harm or even death. As I have discovered in my work, many deaths don’t need to happen.

Yes, everyone dies eventually. You can’t prevent that, but you can prevent it from happening prematurely. And you can do it with the simplest life-saving acts, whether it’s strapping on a seat belt correctly, making subtle changes to your diet or following your doctor’s orders.

That’s not all, either. There are other actions you might not be aware of that can save your life. For example, did you know that open or partially open car windows increase the risk of more severe injuries in an accident? There are many lessons that can be learned from the dead - lessons that can help us, the living, take better care of ourselves.


Most people have never seen what a fatal car crash can do to a body, but I see it almost every day. The injuries from car accidents can be absolutely brutal. Some injuries are so overwhelming that they look like a bad horror movie.

• There are people who would be alive today had they worn their seat belts. Seat belts work because they keep drivers and passengers in their vehicles.

The interior of your car is a far more forgiving environment than the outside of your car. When you’re ejected from a vehicle in a crash, bad things happen. Just as important, you’ve got to use restraints properly.

Roads are most hazardous on Friday and Saturday nights between midnight and 3am 

Danger zone: Roads are most hazardous on Friday and Saturday nights between midnight and 3am
If you wear a seat belt without the shoulder harness, for example, you’re in danger of life-threatening internal injuries.
I’ve seen people who were almost cut in half by the lap belt because they didn’t use the shoulder harness. And if a seat back is reclined, the restraint becomes much less effective, if not useless.

• Air bags save lives, too. Safety experts recommend that seats should be moved back as far as possible to allow air bags to offer the best protection and cushioning when they deploy.

• Often, car accident victims are simply in the wrong place at the wrong time. I never, ever stop my car on the side of a motorway, for example. I’ve had cases in which drivers did this to fix a flat tyre and were rear-ended and killed. If something goes wrong with your car, don’t pull over until you can get to off-road parking, a side-street or petrol station.

• Anything unrestrained in your car can become a dangerous missile, whether it’s shopping, sports equipment or anything else.

• Keep your windows closed. I had one poor fellow - a truck driver - who died when a bee flew into his cab. And if not closed, then roll the windows all the way down. Windows rolled halfway down can cause the most traumatic injuries if you get partially thrown from your car.

• The most dangerous hours to be on the road are Friday night and Saturday night between midnight and 3am. I make sure to stay off the road then.


Bad things can happen to anyone on holiday. I’d be the last person, however, to advise you not to take one, but by packing some common sense, you can make sure you’re doing everything you can to stay safe and well.

• I've seen Deep Vein Thrombosis kill even the healthiest people. Drinking plenty of fluids can help prevent it. On a plane I get up every half-hour or so to move and stretch my legs. I do exercises in my seat, like contracting and relaxing my legs. Even while waiting in the airport terminal, it’s important to keep moving your legs to help blood flow. Get up and walk around when you can.

• The most common cause of death while travelling is heart attack, and it usually strikes within the first couple of days of a holiday. I’ve autopsied many travellers with weak hearts who succumbed to sudden cardiac death, even though they were often walking, talking and feeling fine when it struck.

People who become ill on holiday often ignore unusual symptoms  

Health drought: People who become ill on holiday often ignore unusual symptoms because they don't know where to turn

Often when people are on holiday, they tax their bodies by doing things they’re not accustomed to. Take it easy on your trip.

• People who feel ill on holiday often don’t seek prompt medical attention. It’s unfamiliar territory and they don’t know where to go or whom to call, so they think they’ll ride it out. But please don’t ignore unusual symptoms

 Get checked out as soon as possible. You can get a free list of English-speaking doctors in many countries around the world from the International Association for Medical Assistance to Travellers,

Otherwise, you can usually find English-speaking doctors by contacting the staff at a large hotel or your local consulate or embassy.


People often assume that over-the-counter dietary supplements are safe, but many can have harmful side-effects, especially in high doses. And, with some, you really don’t know what you’re putting in your body and they might be harmful.

I once investigated the sudden death of a healthy 49-year-old woman. She exercised every day. She watched her diet religiously and kept her weight at around eight-and-a-half stone. She didn’t drink, smoke or take drugs.

Her autopsy revealed nothing. Then it emerged that she’d been taking 40 vitamin and dietary supplements every day - one of them was DHEA (dehydroepiandrosterone), a naturally occurring hormone, that’s been promoted as a cure-all for everything from obesity to heart disease to ageing.

She was taking seven times the daily dose - it had affected her heartrate, with fatal results. She died as a result of excessive supplement use.

I think it’s fine to take a daily multivitamin/multimineral tablet, and perhaps other supplements depending on your doctor’s recommendation, but vitamins and minerals can cause problems if taken with some drugs.

Furthermore, the science on supplements is complex and often inadequate. Take calcium, for example. Calcium supplements are known to be helpful and generally safe, yet taking calcium pills might increase the risk of death due to cardiovascular disease in older women.

My simple advice: always check with your doctor about taking supplements


Around 10 per cent of all medication errors are from drug name confusion, and the World Health Organisation says this confusion is an urgent worldwide problem. Fortunately, most errors are preventable with vigilance on your part.

• When you pick up your medicine from the pharmacy or are given medicine in the hospital, ask: Is this the medicine that my doctor prescribed? Researchers at the Massachusetts College of Pharmacy and Health Sciences found that 88 per cent of medication errors involved the wrong drug or the wrong dose.

• Find a pharmacy or chemist that you like and stick with it. A pharmacist who knows you might be more likely to notice something unusual about a prescription.

• Discuss your prescription with your pharmacist - to find out about side-effects and confirm that you’ve got the right medicine.

• Know the colour and shape of the pills you take regularly; examine the actual pills. The name of most brand-name drugs is usually stamped on the tablets. Also, study the label to make sure it matches the doctor’s prescription.

• Check everything before you leave the pharmacy. Lots of people simply pay and run. Make sure it’s your name on the bag. Then take out the bottle or box and check the label as well.

• Find out whether your medicine interacts with other drugs. Even useful, familiar and effective drugs can produce severe side-effects; others pose dangers of allergic reactions or toxic interactions if mixed with other substances.

Know the colour and shape of the pills you take regularly and examine the actual pills 

Medicine minefield: Know the colour and shape of the pills you take regularly and examine the actual pills
The greater the number of medications you take, the greater the risk of drug interactions - the elderly (aged 65 and older) are particularly vulnerable to this.

Ask your doctor (or doctors) to review your treatment plan at least every three or four months. Websites such as or have ‘interaction checkers’ where you plug in the medicine you’re taking to get a list of all the other drugs it interacts with.

• Check whether your medicine interacts adversely with any foods. Grapefruit juice, for instance, can increase the blood levels of some drugs, such as sedatives; calcium in dairy products impairs the absorption of tetracycline and ciprofloxacin, widely used antibiotics. Ask your doctor about food-drug interactions and read the information that accompanies your prescriptions.

• Before leaving the doctor’s surgery, make sure you can read your prescription. If you can’t, your pharmacist might not be able to, either.

Also, ask your doctor or nurse what the medicine is for, how often you should take it and for how long, whether you should take it on an empty or full stomach, whether you should avoid certain foods, drinks or activities while taking it.

Very importantly, ask your doctor what are the potential side-effects — and what you should do if these side-effects do occur.

• Unless it’s essential, don’t use any prescription drug within two years of approval. Drugs are approved on the basis that a relatively-small number of studies show that a drug works and is safe. But it might not be until the drug has been on the market for a couple of years, and millions of people have used it, that infrequent but serious problems surface.


Modern medical care is wondrous, but it’s complex. The things that can go wrong in a hospital are almost innumerable. But that doesn’t make them right or acceptable. Health care, instead of helping, might cause needless harm or, worse yet, kill you.

You must do what you can to ensure your hospital stay puts you on the path to recovery - and not to the morgue.

• Insist that anyone who has direct contact with you washes their hands, even before they put on protective gloves: if someone’s hands are unclean when they put on gloves, the gloves might become contaminated.

• Urinary tract infections are actually the most common type of infection originating in a hospital. Bacteria can slip into patients via urinary catheters, and these infections can be dismayingly tenacious.

Urinary catheters also limit your mobility, which then increases your risk of blood clots, pneumonia and muscle loss. While urinary catheters are sometimes necessary, the longer the catheter remains in place, the more likely you are to get an infection or other complication.

It’s often possible to avoid the catheter and a resultant urinary tract infection by using nappies or a bedpan instead.

• Pneumonia is another common hospital-acquired infection. The risk is shallow breathing which makes it easier for bugs that cause pneumonia to get a foothold.

Modern medical care is wondrous yet complex - with innumerable things that can go wrong 

Double-edged sword: Modern medical care is wondrous yet complex - with innumerable things that can go wrong
Shallow breathing is common during recovery from surgery or any other treatment - you might naturally take shallow breaths because you’re on your back and breathing deeply might be painful.

Also, after surgery, your lung tissue might have partially collapsed (a condition called atelectasis).
Deep breathing will help prevent pneumonia, and hospital staff can give you a device called an incentive spirometer; blow into it several times every day to strengthen lung capacity.

As soon as you are able, with assistance, get out of bed and walk around the hospital floor. Do this several times a day. Becoming mobile as soon as you can prevents atelectasis.

• Have your doctor sign his or her initials directly on the site to be operated on prior to the surgery. You’ll be less likely to make ‘Doctor Removes Wrong Kidney’ headlines.

• When a nurse comes to give you medicine, ask what it is and why you need it. Make sure the nurse checks your ID bracelet against the name on the prescription. Medication errors are common in hospitals.

• The longer you’re in the hospital, the higher your risk of complications. Do everything your healthcare team asks, so you’ll be able to leave quickly. In many cases, it’s better to continue your recovery at home,
anyway, away from the hum and beep of machines, the clatter of the food trolley and the loud conversations between nurses.

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