Review of "99 Ways to Die and How to Avoid Them" by Ashely Alker, M.D."

  

Dr. Ashely Alker is an emergency medicine doctor as well as an educator concerned about public health and preventative care. Alker wrote this book to help people avoid 'the ninety-nine most terrifying, interesting, and unfortunate ways to die, ranging from everyday household poisons to regrettable sex'.

Also, since many people believe what they see in films and television/streaming series, Alker has worked with screenwriters and producers to increase medical accuracy in Hollywood. So far Alker has consulted for The Act, The Handmaid's Tale, Bull, Station 19, Chicago Med, Purple Hearts, and many others. Alker writes, "The purpose of my work is to create truth in art, giving viewers a more valid theatrical experience that is passively educational and avoids health misconceptions."


Author Ashely Alker

This book isn't for hypochondriacs!! Reading the book from cover to cover might give the false impression that a person's life is in danger every day from some combination of infectious microbes; allergies; poisons; pregnancy; eating beef; insect and arachnid bites; injuries; parasites; weapons; animal attacks; drinking too much water; dog kisses; and so on.



Luckily, Alker lightens the mood with a good sense of humor and funny anecdotes.



Alker suggests, "Don't let Lassie kiss your face, I don't care how famous he is." Dog kisses can spread
Guillain-Barré syndrome, a rare condition that causes sudden numbness and muscle weakness.

For deadly threats of various kinds, Alker discusses their history; patients she's treated; methods of disease transmission; symptoms; prevention; treatment; famous victims; death toll; and more. Alker also gives useful advice, such as: get vaccinated; be prepared; use common sense; and when you sense something is wrong - get to an emergency room or hospital quickly.

The book is VERY inclusive and detailed, but in a nutshell, the topics are:

◈ Infections: Bacterial, Viral, and Parasitic.

◈ Vaccine Preventable Diseases: Smallpox, Polio, Flu, etc.

◈ Heart Diseases: Heart Attack, Arrhythmias, High Blood Pressure, etc.

◈ Brain Diseases: Mad Cow Disease, Stroke, Dementia, etc.

◈ Sex: Pregnancy, Syphilis, Herpes, Butt Stuff, etc.

◈ Drugs: Medications - Over-the-Counter Products, Herbal and Dietary Supplements, etc.

◈ Drugs: Recreational - Opiates, Psychedelic Mushrooms, Nicotine, Alcohol, etc.

◈ Animals: Snakes, Spiders, Sharks, Scorpions, Jellyfish, etc.

◈ Poisons: Cyanide, Carbon Monoxide, Deadly Nightshade, Pesticides, etc.

◈ Food: Anaphylaxis, Pufferfish Tetrodotoxin, Fish, Poisonous Mushrooms, etc.

◈ Locomotion: Cars, Motorcycles, ATVs, Helicopters, Planes, etc.

◈ Crime: Murder, Gun Violence, Serial Killers, etc.

◈ The Elements: Lightning, Tornadoes, Earthquakes, etc.

◈ Warfare: Biological, Chemical, and Nuclear Weapons.

To provide a feel for the book I'll give a few examples, chosen at random for variety and interest.

INFECTION

➼ Strep Throat

Strep throat is caused by Streptococcus bacteria, which infect the throat and tonsils. Antibiotics are prescribed to kill the microbes, and it's important to take the FULL ROUND of antibiotics to prevent the development of resistant germs.

Left untreated, a prolonged strep infection can cause rheumatic fever, a disease that causes heart inflammation, arthritis, rash, skin nodules, and a body shaking syndrome called Sydenham's chorea. Serious cases can result in kidney failure or the need for a heart transplant.




Sydenham's chorea can cause body shaking

➼ Necrotizing Fasciitis

The various bacteria that cause necrotizing fasciitis eat away at body tissues in a process called liquefactive necrosis, turning flesh into a gray soup. The symptoms begin as a normal skin infection, but the redness, pain, fever, and sometimes blisters on the skin then progress rapidly.

One of the causes of necrotizing fasciitis is a bacterium called Vibrio vulnificus, "which is not a Hogwarts spell but a saltwater bacterium." If you get cut in the ocean or brackish water, wash the cut thoroughly and seek medical care.


Necrotizing Fasciitis

TICK-BORNE DISEASE

➼ Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever is a bacterial disease spread by tick bites. Usually, on day seven after the tick bite, the victim gets a headache and fever, followed by a rash that looks like bright red freckles covering the entire body.

Rocky Mountain Spotted Fever is deadly because the bacteria damage cells that line the blood vessels, causing blood leakage and blood clots, and sometimes infections in the brain, heart and liver. The illness is treatable with the antibiotic doxycyline.


Tick and rash associated with Rocky Mountain Spotted Fever

PARASITES

Alker notes, "Swine can carry up to forty different parasites...The problem is pigs are known to eat a little poo from time to time and it comes with worms...I bet a lettuce and tomato sandwich is looking pretty good right now."

➼ Pork Tapeworm

Taenia solium is the pork tapeworm. If a person eats undercooked infected pork, the immature stage of the parasites - called cysticerci - infect the gut and grow into flatworms that can live for years. Treatment is easy with praziquantel or albendazole pills.


Pork tapeworm (left) and pork tapeworm in human intestine (right)

If the cysticeri get to the brain, they cause a disease called neurocyticercosis, which is the primary cause of preventable epilepsy in the world. One victim may have been Robert F. Kennedy, Jr., who claimed he had a worm in his brain. Without treatment, 'brain worms' can cause headaches, blindness, meningitis, stroke-like symptoms, and death.


Mulitple cysticerci in the brain

BRAIN DISEASE

➼ Stroke

Most strokes are caused by blockage in a blood vessel carrying oxygen-rich blood to the brain. This results in death of brain tissue. Symptoms of stroke may include facial droop, numbness, arm and leg weakness, vision loss, slurred speech, and inability to understand speech.

Clot-busting medications can be given up to several hours after the onset of symptoms, but the more time passes, the more brain tissue dies. So never ignore stroke symptoms, and go the emergency room immediately.


Stroke victim

➼ Brain-Eating Amoeba

Alker says, "Have you ever swum in the peaceful waters of a lake? Used a neti pot for a sinus rinse? Taken a dip in a river or stream? If so, this chapter will terrify you."

The Naegleria fowleri amoeba is a freshwater brain-eating amoeba that is almost always fatal. The organism infects humans by entering through the nose when people swim in contaminated water, or when neti pot water is contaminated.

Symptoms include headache, nausea, vomiting, neck stiffness, fever, seizure, altered mental state, and hallucinations. Severe brain swelling eventually leads to brain herniation (shifting in position) and death.




A woman using a neti pot for a nasal rinse

Alker suggests, "If you happen to be swimming in warm, unchlorinated fresh water, maybe keep your head above the surface. Also, sterilize water used for neti pots."

SEX

➼ Butt Stuff

Alker notes, "One thing every emergency department sees too much are rectally inserted objects. This throws nonmedical folk off, but honestly when you are tired, covered in coffee, and trying to save lives, the person with stuff in their butt is the least of your problems.....Doctors do not care how the TV remote you "SAT ON" got into your butt."

Alker suggests, "There are safe items made for rectal stimulation. Be brave: Go to a sex shop, wear a hat and glasses, and pay in cash, or go online and use a friend's credit card."

Nuff said about that subject.

DRUGS

➼ Over-the-counter medications

Alker describes treating a child with depression who had taken vitamins in his mother's medicine cabinet, to try to hurt himself. The child had overdosed on iron and was going into shock, meaning his blood was not getting oxygen to his organs.

Symptoms of iron poisoning include nausea, vomiting, and diarrhea. Subsequently, the blood turns to acid, and the iron causes bleeding, and liver, heart, and kidney dysfunction. Once shock and liver failure set in, the only treatment may be a liver transplant.

An intravenous antidote, deferoxamine can alleviate the symptoms of iron poisoining, but must be used early, as iron has a rapid effect.



POISONS

➼ Carbon Monoxide

Carbon monoxide (CO) gas is tasteless, odorless, and deadly. CO replaces oxygen in red blood cells, so organs can't get the oxygen they need. CO is released by fire or combustion, and is given off by cars, stoves, fireplaces, furnaces, house fires, and so on.



The first symptoms of CO poisoning are headache, dizziness, nausea, and vomiting. Eventually, decreased oxygen to the brain can cause a stroke, and decreased oxygen to the heart can cause a heart attack. CO kills by concentration, which is why the gas is most dangerous when trapped indoors. The solution is dilution (open the doors and windows), or just not polluting in the first place.



Alker observes, "The best advice for avoiding CO poisoning is to get a CO detector. It's like twenty bucks. When you are done reading, you can sell this book and get one."

FOOD

➼ Fish Poisoning

Alker says, "While most food poisoning is caused by picnic potato salad on a sunny day, or street meat contaminated with bacteria, fish are associated with a unique set of poisonings....pufferfish is not the only fish that can take you out at dinner."

Scromboid poisoning is one of the most common types of fish poisoning, and is caused by too much histamine in ingested fish. Histamine causes an allergic reaction, and makes you itch, sneeze, flush, and break out in hives. In severe cases, it can cause breathing problems such as wheezing and airway closure.

The FDA recognizes both fish and shellfish as major food allergens. Scromboid can be caused by tuna, mackerel, bonito, skipjack, mahi-mahi, amberjack, bluefish, marlin, swordfish, herring, anchovies, sardines, salmon, trout, and tilapia (so....almost anything). Scromboid is more common in recreationally caught fish than commercial fish.



Scromboid is rarely deadly, and can be treated with antihistamines for low-risk reactions. Serious symptoms, like breathing problems, require hospital treatment with IV medications and supportive care.

THE ELEMENTS

➼ Lightning

Alker observes, "Lightning has been of human interest throughout history....this may be why the most powerful god on Olympus, Zeus, wielded lightning, and why it is the power of the second-best X-Men character."



According to the CDC, there are more than eight million lightning strikes every day, to trees and other tall structures.



The primary way people die from a lightning strike is cardiac arrest: the lightning disrupts the electricity of the heartbeat causing a fatal arrhythmia and the heart to stop beating.

If someone is hit by lightning, the CDC recommends immediately starting CPR and calling 911. Alker suggests, "If you don't know CPR, put this book down and go take a class, especially if you have kids."

*****

I hope my examples give you a feel for the book's contents, which provide a great deal of information you might find useful - or even life-saving - some day. It's a lot to take in, so I'd suggest reading the book a little at a time.

Highly recommended.

Thanks to Netgalley, Ashely Alker, and St. Martin's Press for an ARC of the book.

Rating: 4 stars