Nine Practical Tips on How To Avoid A Death Like Heath Ledger’s

More heartbreak. The New York City Coroner announced today that Heath Ledger’s death was an accidental overdose. The word accidental is insider code for the fact that none of the blood levels of any one of his medicines was high enough topill-bottle_1.jpg mean that Heath Ledger tried to kill himself–they were all in the range of day-to-day dosing. It was the combination of all their side effects that killed him (for more information, read the prior Doc Gurley post, Was Heath Ledger Snoring?). AP reports that “the actor’s father, Kim, said Wednesday: “While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal for our boy. Heath’s accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage.””

When you hear about this kind of thing–the accidental death of someone who was obviously very bright (you try memorizing an entire movie’s worth of lines) and outrageously young and healthy, it can shake you up. How do you prevent it from happening to yourself or someone you love? So, in honor of this talented actor’s memory, here are nine practical Doc Gurley tips to learn and share on exactly how you can protect yourself, or someone you love.

1) You need a buddy when you can’t sleep. Here’s another alarming, heartbreaking quote from AP: “”Last week I probably slept an average of two hours a night,” Ledger told The New York Times. “I couldn’t stop thinking. My body was exhausted, and my mind was still going.” He said he had taken two Ambien pills, which only gave him an hour of sleep.” Bottom line for overdose prevention–when you don’t sleep, you don’t have any judgment. But the really scary thing is, you think you do. How do we know this for a fact? From studies of sleep-deprived doctors. Furthermore, medicines for anxiety, pain and sleep also impair your judgment. We’re talking about a perfect storm of judgment-impairing factors. Add suffering to the mix, and the usual human impulse is to take more and more, hoping for relief. What’s a person to do? Here’s a practical rule for yourself and your loved ones–if someone has not slept for more than two hours for more than three days, they should not be taking any medicines “as needed” without entrusting someone else to help them keep track. No sleep means you need the buddy system.

2) Acknowledge that you’re only human. No matter how young, sharp or cool you are–you need a pillbox in your house, waiting for you to use it. Without a pillbox, it is inevitable that, one day, you won’t remember if you took your medicine or not. When we hold that orange plastic prescription pill bottle in our hand, trying to remember if we took one yet, we’re playing the world’s most dangerous game of double-or-nothing. What do I mean by double or nothing? Well, if you forgot to take a dose before, and now can’t remember, and you decide to not take one–you’re now taking nothing. For some diseases, like a really bad infection, taking nothing for even one dose can mean a nasty germ resistance (HIV medicines are really important to never skip, even one dose). That’s the nothing. What about the double? If you took one dose before, and forgot that you did, and you take another one now, you’re taking double the prescribed dose. For some drugs, that’s probably okay. It is honestly quite hard to overdose on penicillin, for example. But for other drugs, like the ones Heath took (especially pain pills, sleeping pills, and anxiety pills), double can mean death. We all ought to have and use a pillbox all the time. Studies have shown the tremendous positive impact they can have on reducing medication errors of all kinds. Give everyone in your house a cheap plastic pill box with their name in Sharpie on it. Give one as a college going-away-present for friends, kids, grandkids. No one is smart enough to always remember exactly what they took, when.**Keep in mind, however, that pillboxes are not childproof, and store them safely!

3) Keep track. If your doctor gives you a prescription for a medicine to take “as needed,” here’s how you use the pillbox. Fill it with the maximum dose per day you are supposed to take for a week. Never add more. At the end of the week, see how many you took, and take that information back to your doctor. Now you and your doctor have a much clearer idea of what’s going on, than the usual “I don’t think it’s working” approach.

4) Don’t forget the “little” things. Bring every pill in when you go to see your doctor. If you don’t want to haul them all around, make a list, but make a list of everything, including over-the-counter items like cough syrup (which killed the rapper Pimp C last week) and antihistamines (which contributed to Heath’s death). People unfortunately often think their doctor is more on top of things than he actually is. Your doctor may have forgotten she prescribed that antihistamine last spring. The notes for why she prescribed the anxiety meds, and when she added a second one, may be lost in medical records. Bring everything in, every time. One easier way to do this, if you’re on meds for more than a week, is to print the list on your computer, then tape it to the back of your pillbox. Then you’ve got a handy, small box with the list on the back, and what you actually took, inside.

5) Take the time to treat yourself right. In case you’re thinking the whole pillbox arrangement sounds like a lot of trouble for medicines you’re only taking for a little while (just until I finish filming this movie, just until I get this grant completed, just until finals are over, just until the house remodel is done), keep in mind this extremely important tip–accidental overdoses are absolutely more frequent when someone starts a medicine. When you start a pill is when you and your doctor aren’t yet sure how strong a dose you need. You don’t have any habits about taking it regularly, and you’re likely to end up playing double or nothing. And, when starting a new medicine means you’re adding a second pill, neither you nor your doctor can know how big an effect it might have. Starting any medicine is when you’re at most risk.

6) Dont’ restart medicines. Here’s the second most common scenario for accidental overdoses–when you restart medicine. Don’t re-use the same doses in the same pillbox if you haven’t taken a medicine because you were doing well. Restarting medicine on our own is a big temptation for all of us. Say you remember how much medicine (pain pill, anxiety med, sleeping pill) you used to take. You got better, you’ve been doing great. You stopped taking them for a while. Now you’re having a bad spell and it’s going to be a while before you can get in to see the doctor. What’s wrong with just re-starting while you wait? Won’t that speed things along? Well, yes, if what you’re hoping to speed along is a disaster. See, your liver is no longer revved up to handle the medicines. Now that you’ve been medicine-free (for even a month), if you take the same dose you used to take, it can kill you.

7) Don’t die of embarrassment. If you are worried about confidentiality in your life (you’re a celebrity, you live in a small town, you have a position of prominence, or a job-that-can-be-lost-if-this-comes-out), this means that you need to have a plan for any and all potentially “embarrassing” health problems–optimally before they occur. Scout out a doctor who will see you for cash only (no records). Find a psychiatrist who can absolutely be trusted (and, if you feel you need to, see if they will list your problem as “insomnia” no matter what’s going on). It is tragic to think of someone suffering and unable to get help because someone might find out.

8) Serial monogamy is the only way to go. By the time a problem involves multiple medicines, this means that one person with medical training should be watching out for you, and making sure you’ve gotten a thorough assessment. The phrase that many cooks spoil the pot is true, only more so with doctors. A tasteless meal won’t kill you. Lots of docs can. Pick one, any one. You don’t have to stay with him forever, but you do have to make an orderly exit. In other words, what you want when it comes to doctors is serial monogamy. Bouncing from doctor to doctor (what is called doctor shopping) can kill you. Imagine that each of these serious medicines is an airplane. When you doctor-shop, you have no air-traffic controller coordinating and overseeing them all–instead you have a room full of blind air-traffic controllers, shouting and steering things in all directions. This is a sure-fire way to end up with a lethal collision of drugs.

9) Know when you’re heading into dangerous territory. Self-treatment is a fact of life in America. Whether you self-treat because you can’t afford healthcare, or whether you self-treat because you’re afraid of losing your privacy, people are doing it all across America. If you buy pain meds, sleeping pills or anxiety medicines online, you’re gambling with your life. These are particularly dangerous meds to take (even alone, but especially in combination). People borrow their friend’s antibiotics, even though they know they shouldn’t. We go to the drugstore and hunt around for a pill for our cold, our constipation, our rash. Self-treatment like this is not so likely to kill you–kind of like doing your own plumbing, you might end up soaked, but that’s usually about it. However, self-treating with pain meds, sleeping pills and/or anxiety pills is more like doing your own naked-wire, high voltage electrical hookup to a main. The risk is not the same. That @#t can kill you. Get help. Go to a free clinic, have one visit at an urgent care center and pay cash, go anonymously to Planned Parenthood, whatever you have to do, sit down with someone with training and talk to them about your problem, dosing risks and everything you’re taking. If you’re wavering and thinking your problem might pass, and you’re not sure what you might gain by going to see someone, keep in mind that whatever you’re afraid of losing by getting help (money, privacy, spouse, job), if you make one mistake, you can lose it all in the end. Whatever the cost, help is worth it if it saves your life.

There are many reasons why people give up or lose their lives. A preventable mistake is such a tragic way to go. Guess it’s time for another Doc Gurley box of tissues and trip to the DVD store. Heath was sooo great in Ten Things I Hate About You. For many of us, it’s Brokeheart Mountain time.

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