Questions remain over Danny Gans' death

Las Vegas performer suffered from chronic pain syndrome

LAS VEGAS -- Danny Gans' act came at you full speed with song, dance and impressions ranging from Joe Cocker to Sammy Davis Jr., Louis Armstrong and Kermit the Frog.

Crowds who packed the theater night after night to see one of the Las Vegas Strip's top performers could never tell what was coming next, or that the energetic performer was wracked by chronic pain that would contribute to his accidental death.

"If he was in pain, he would just suck it up and go on with the show," Chip Lightman, Gans' longtime manager and friend, said Wednesday. "Dan wasn't a complainer."

On Tuesday, the Clark County coroner provided a peek behind the curtain with a declaration that Gans' death May 1 was accidental -- resulting from a reaction to an unspecified dose of the powerful prescription painkiller hydromorphone.

"He was suffering from chronic pain syndrome," Coroner Mike Murphy said, ending weeks of speculation while an autopsy and toxicological and microscopic tests were conducted.

Murphy blamed Gans' death on "acute hydromorphone toxicity," and said Gans also had hypertensive cardiovascular disease, a high blood pressure condition, and a condition called polycythemia that caused his red blood cell count to go up. Polycythemia is the opposite of anemia.

"This is not an issue of drug abuse," Murphy said, attributing Gans' death to "the hydromorphone and ... the combination of those issues."

Lightman, who said he spoke about the coroner's findings with Gans' widow, Julie, said he was stunned by the coroner's findings.

"I think Julie, like me and everyone else who knows Dan, is thinking, 'How could he be doing this with chronic pain?' " Lightman said. "But Danny was an athlete. He worked through it."

Lightman said he thought Gans avoided taking pain medications, fearing it would affect his vocal cords and his singing.

"I'm being haunted by the question that everyone else is," Lightman said. "Who gave him this prescription?"

Murphy and the medical examiner who conducted Gans' autopsy, Gary Telgenhoff, cited patient and family confidentiality in refusing to identify Gans' physicians or say how long the entertainer suffered from pain. He also would not say much hydromorphone was in Gans' system, or whether he took other medications.

Lightman said Julie Gans didn't know her husband had hydromorphone, which is commonly marketed under the trade name Dilaudid.

"Do I think he was taking it and doing the show?" Lightman added. "No, I don't know how he could've."

"All I can figure is he tweaked his shoulder or his back and he decided to take something," Lightman said. "It makes sense that he took something on a Thursday, a day off, knowing he didn't have to do a show until Friday night."

Bradley Williams, a professor of clinical pharmacy and gerontology at the University of Southern California, called hydromorphone three to five times more potent than morphine.

Mel Pohl, medical director of a Las Vegas drug abuse treatment center and author of two books on chronic pain recovery, ranked the drug close to the top of the spectrum of analgesic narcotics, and less commonly prescribed than painkillers such as Lortab and Percodan.

"Hydromorphone is not something that's prescribed for mild pain," he said.

Pohl called the coroner's listing of chronic pain syndrome as a cause of death "a little peculiar."

"I think what they were trying to imply is that he had chronic pain, he was taking this medication to address that, and the treatment ended up backfiring partly because of his medical condition," Pohl said.

"That's the lesson," he said. "Medications often don't do what we want them to do."

Hydrocodone is a semi-synthetic opiate sometimes used in palliative and hospice care. It was one of many drugs prescribed to Anna Nicole Smith, according to a criminal complaint filed in Los Angeles against Smith's boyfriend and two doctors. Smith was declared dead at a hospital in 2007 after being found unconscious in her Florida hotel room. She was 39.

Gans' death at age 52 stopped a rising star a little more than 12 weeks into a headline gig at the 1,500-seat Encore Theater at Wynn Las Vegas hotel-casino.

He didn't perform the night before his wife summoned paramedics to their sprawling, gate-guarded Henderson home with a report that Gans had trouble breathing and wouldn't wake up.

Pohl called it "worrisome in retrospect" that Gans took a strong narcotic that could make him breathe more slowly if he had an existing heart condition and a low level of oxygen in his blood due to his polycythemia.

Alan Barbour, a forensic toxicology consultant in Fresno, Calif., said Gans' existing medical conditions could have made him less tolerant of the painkiller.

"A debilitated patient can be pushed over the edge by drug levels that wouldn't necessarily be harmful for someone in good health," he said.

Lightman said he was aware that Gans was being treated for the blood condition and high blood pressure, and knew the performer suffered back and shoulder pain dating to when he was a minor league baseball player.

"His show was so intense on his body," Lightman said. "The first 10 minutes was rapid-fire, and every night the show was different. He tailored it to the audience."

"It was a one-man show -- him and the band -- an hour and 45 minutes, running all over the stage constantly," Lightman said. "It was all high-energy, vocally and physically. He had to be in the best shape, like an athlete."

Lightman said Gans suffered disc pain in his back and had two shoulder surgeries since closing his show at The Mirage last year.

"He would strain his back at times, but the pain with his shoulders was constant," Lightman said. "He had rotator cuff problems, and in the show he was always moving his arms up, around and down, every which way."

Gans got massages three times a week, stretched and worked out at a gym at his home, Lightman said.

"Danny worked out regularly. He ate well. He was very careful," Lightman said.
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