Q&A with Dr D. P. Lyle!

JUNE 2011 

Heartbeat members were thrilled to have Dr Lyle with us recently for a Question and Answer consultation!

Bio:
D. P. Lyle, MD is the Macavity Award winning and Edgar Award nominated author of the non-fiction books, MURDER & MAYHEM, FORENSICS FOR DUMMIES, FORENSICS & FICTION, andHOWDUNNIT: FORENSICS as well as the thrillers, DEVIL’S PLAYGROUND, DOUBLE BLIND, and STRESS FRACTURE, the first in his new Dub Walker Series.His essay on Jules Verne’s THE MYSTERIOUS ISLAND appears in THRILLERS: 100 MUST READS. His next Dub Walker novel, HOT LIGHTS, COLD STEEL, and the first of his Royal Pains tie-in novels,ROYAL PAINS: FIRST,DO NO HARM, will be released June, 2011.

He has worked with many novelists and with the writers of popular television shows such as Law & Order, CSI: Miami, Diagnosis Murder, Monk, Judging Amy, Peacemakers, Cold Case, House, Medium, Women’s Murder Club, 1-800-Missing, The Glades, and Pretty Little Liars.

Website:
http://www.dplylemd.com/
Blog:
http://writersforensicsblog.
wordpress.com/

So we snapped on the latex gloves, put a fresh blade in our scalpels and got to work with Dr Lyle!

QUESTION from WENDY S. MARCUS

"I'd like to know about childhood leukemias and what on-going problems a sufferer might have. Could the condition return when the patient reaches adulthood?"

Answer: ALL and AML are acute leukemias that typically strike during childhood. Each of these are distinct types of leukemia and arise from different cell types within the bone marrow. Treatment consists of various types of chemotherapy and in some cases radiation therapy and the protocols for these evolve year-by-year. The best cure for these leukemias is a combination of aggressive chemotherapy to wipe out the bone marrow completely and then to replace it through bone marrow transplant or stem cell infusions. These can be quite successful but they are not 100% so.

Your young victim could have an incurable type and yet reached remission through chemotherapy. He might require chemotherapy often on through the years for recurrence and indeed this could stretch into adulthood with good medical care and luck. So your scenario will work. Simply have him develop one of the leukemias, with ALL being the most common but AML being the one most likely to recur later in life. Of course all bets are off since whatever happens, happens. He could be diagnosed at age 5 or six and be treated, then maybe have a relapse a few years later and another a few years after that and finally one in his early 20s. Or he could possibly going to relapse for many years and then have it recur and only have a minor problems in the interim.

Here are a couple of links:

http://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia
http://en.wikipedia.org/wiki/Acute_myeloid_leukemia

QUESTION from DIANNE DRAKE

“I’m interested in learning more about Asperger’s syndrome and whether there are ailments that might mimic the condition.”

Answer: Asperger’s syndrome is in the spectrum of diseases that include autism on the worst end and ADHD on the less severe end of the spectrum. The signs and symptoms were multiple and diagnosis is difficult and controversial. It is both underdiagnosed and overdiagnosed. In fact it is become almost a waste basket diagnosis for children with any odd behavior. There many reasons for this but mostly because it is poorly understood and children who behave badly must have something wrong with them other than poor parenting. So the diagnosis of your character could be erroneous or could be overplayed or could be missed altogether.

Very few children who are affected by the syndromes have the gifts that you talk about. Things such as mathematical, musical, or memory ability. These things do happen but they are not that common and if so often go unrecognized.

Any number of other diseases both psychiatric and physical could cloud the diagnosis and perhaps create the confusion you are looking for. Simple things such as hypothyroidism and even hyperthyroidism could be present. Each of these can have behavioral components and each is easily treatable. If they are recognized. Of course testing the thyroid should be part of any evaluation of the child with any of these syndromes or if they are suspected of having them. Also things such as schizophrenia and bipolar disorder can be underlying problems. Poisoning with the heavy metals arsenic, lead, or Mercury could also cloud the picture to some extent. The use of amphetamines and some other drugs of abuse could also confuse things. Even diabetes with wildly fluctuating blood sugar levels can cause bizarre behavior with confusion, disorientation, temper tantrums, lethargy, and a host of other symptoms, which can easily make ADHD appear much worse.

Your parents, even though they are physicians, may fail to recognize these underlying diseases and problems. They are too close to the problem. They do not look at their children objectively. They see the child every day and therefore gradual alterations in behavior might go unnoticed or might simply be written off to his Asperger’s Syndrome. So your child may just have a mild form of ADHD that one of these complicating factors was making it appear more like Asperger’s and only when this is uncovered with the true diagnosis be made. I hope this is what you were looking for.

http://en.wikipedia.org/wiki/Asperger_syndrome

QUESTION from KITTY TAYLOR

"What are the earliest and the mildest symptoms a 30-year-old patient with Multiple Sclerosis can expect to have?" 

Answer: The early diagnosis of MS is very difficult and very often the disease has to progress for many years and sometimes decades before the diagnosis becomes apparent. The victim might suffer numbness and tingling of his extremities, hypersensitivity to certain areas of the skin, visual disturbances including blur double vision, abnormal movements of his arms and legs, mood swings, depression, muscle twitches and spasms, difficulty with or hoarse speech, difficulty with swallowing, and a host of other symptoms. These can occur in any combination, any order, and in any degree of severity. They often come and go. The victim might have double vision for a few days and then everything returns to normal. He might be afraid to go to the physician or to complain to anyone about the symptoms and then when they go away forget about them. This is true of all the symptoms described above so as it chugs along and the symptoms wax and wane it may be years before an individual seeks medical evaluation. And when this is done the diagnosis is not always straightforward even by a competent physician. So your character could easily have any combination of these symptoms in any degree of severity and often on in any pattern that you want for almost as long as you wanted to go before the diagnosis is made.

QUESTION from CATHY SHOUSE

"In what cases would an autopsy be performed and how soon might results be released?"

Answer: Whether an autopsy is done or not is completely up to the medical examiner or the courts. Either can order an autopsy. The medical examiner must determine the cause, manner, and time of death as part of his evaluation and he will do what’s necessary to make this determination. If he feels he can do it accurately without an autopsy then one will not be done. Why go to the expense if you already know the answer? Someone shot in the chest might not get an autopsy. An elderly person who falls dead and has known coronary artery disease might be written off as a heart attack and no autopsy is done. It happens every day.

The situations where autopsies are almost always done is when there is some confusion about the cause of death, what is involved in a criminal or civil proceeding, when the death is unexpected and unexplained, when a death occurs in an industrial situation or in jail, when the death occurs within 24 hours of hospital admission or any person who is admitted unconscious and never regained consciousness, or when the death occurs after a surgical procedure. There are others but these are the most common reasons that an autopsy should or must be done. But again at the end of the day it’s up to the medical examiner whether it is done or not. It is more likely to occur in a more sophisticated setting and less likely in a small town where the budget is small and the coroner might not be the sharpest knife in the drawer.

An autopsy can be done in a couple of hours or a couple of weeks. The actual procedure can be done in our so but often there is a backlog, particularly in larger jurisdictions, that caused delays in the performance. As to when it would be released to the newspapers would depend upon the medical examiner. Often his report is not filed for several weeks in a complete autopsy because he has to wait for ancillary test such as toxicological testing to be returned before he can file his final report. Medical examiners are often reluctant to speak about autopsies until they are absolutely complete and he can say with certainty what he found.

Dell tops the procedure is pretty much the same everywhere but the level of competence and aggressiveness and experience of the individual medical examiner or coroner varies greatly from jurisdiction to jurisdiction.

QUESTION from SHARON ARCHER

“What would be the best immediate response for a severed femoral artery by bystanders who have medical qualifications?”

Answer: The initial treatment is to clamp or tie off the damaged artery above the wound in order to prevent the victim from bleeding to death. Saving the leg in this circumstance is of secondary importance because if the bleeding of a damaged femoral artery, which is rapid and severe, is not controlled the victim bleed to death in a matter of minutes. The first step would be to apply pressure directly over the wound–enough pressure to compress the artery and stop the bleeding. Then an incision would be made above the injury and down to the artery in order to isolate it. A hemostat–basically surgical pliers–would then be used to clamp the artery or alternatively anything could be used to tie it off. A shoestring, a strip of leather, anything that would work. Then he would need surgical repair of the injury by someone trained in this arena. An emergency room doc, a surgeon of course, a medical student who had spent time on the surgical wards, a paramedic, a military medic, are almost anyone who was smart and aggressive and new enough anatomy to know what to do could repair it to some degree. Not perfect, but perhaps enough to save the victims life.

Getting control ofthe bleeding and tying off the artery is fairly simple and the skills and experience of the person doing that could be minimal. But to do an adequate repair the damaged artery would require a trained surgeon and hopefully a vascular surgeon.

QUESTION from DONNELL BELL

"Is it likely that a pathologist might also have a forensic dentistry qualification? Also, I’d like my coroner protagonist to not have completed medical school. Is this feasible?"

Answer: It’s possible that your character could be trained in both forensic dentistry and forensic pathology but not likely. Forensic dentist go through dental school wallop apologist goes through medical school and then on into a pathology residency followed by a fellowship in forensic pathology. He could of course then go and train in forensic dentistry but this would be to professional schools that he would have to attend and it would take him many years to do so. Possible, just not likely.

The job of coroner in most jurisdictions has very little prerequisite. Basically be over a certain age, live in the jurisdiction, and not have a criminal record. And of course be either electable or appointable to the position. That’s it. The coroner can be the local pathologist, the local undertaker, the sheriff, or the guy who owns the coffee shop on the corner. If the coroner has no medical experience he will simply ship off all the medical stuff such as autopsies to a larger jurisdiction such as a state or regional lab. Remember the coroner is responsible for all things death and must sign the death certificate but it is not required to have medical training. He can always contract for that. So the commission could easily appoint your character to the job either temporarily or permanently. This would be true whether she attended medical school or not.

Medical examiners on the other hand must be physicians so the county where your story takes place must be one that uses the coroner system and not the medical examiner system. These vary from county to county throughout the country.

So that wraps up today’s consultation!  A huge thank you from Heartbeat members to Dr D. P. Lyle for sharing his medical expertise with us!