Bulgaria - Lars Mittank, 28, German tourist, Varna airport, 8 July 2014

Discussion in '2010's Missing' started by dotr, Jan 30, 2017.

  1. katydid23

    katydid23 Well-Known Member

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    Is that what they think he might look like now?

    I wouldn't think he'd look that much older and unkempt unless he didnt have his faculties.
     
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  2. Lavinia

    Lavinia Active Member

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    I have never heard of a Dr. requesting (or requiring) a patient check with an airport clinic prior to flying. Wasn't he already cleared to fly? I assumed airport clinics were for spur of the moment injuries or illnesses. Was the Dr. who examined him and prescribed the infamous rx ever identified or interviewed?
     
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  3. Giuc0

    Giuc0 Well-Known Member

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    Documentary video in English:

    The antibiotic was taken in accidental overdose (up to 1000mg/24 hours, and he took 3 tablets of 500mg the same day).
    The manner is nothing calling into question.

    Actually, the antibiotic was prescribed by the ENT doc at St Anna hospital, Varna. Not by the airport doc.

    What I find very bizarre is that no one, and absolutely no one, checked with Poison Control Centre.
    You have all the evidence for an overdose the day before he went missing, his behaviour showed psychotic symptoms but no LE called Poison Control Centre for advice?

    Any ordinary citizen can call for advice. Why no LE officer, in Germany or Bulgaria, didn't call?
    A German LE officer can call in Germany, Bulgarian LE can call their nearest Poison Control Centre.

    I find even more bizarre that no LE officer involved in the case didn't even think about such basic enquiry.
    I am shaking my head.
     
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  4. Bit of hope

    Bit of hope Have a nice day!

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    Hi there old friend.
     
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  5. Giuc0

    Giuc0 Well-Known Member

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    Hi BOH :)

    The documentary is also available in German, but English version is very fine.

    It clears plenty of misunderstandings. The documentarist is involved with searching Lars. So, it's very difficult to get more reliable info.

    Waiting for my nearest Poison Control Centre answer about the overdosed antibiotic: it can help the family more likely than not.

    OMG! I forgot to link Canadian monography for cefprozil, the infamous active medicine. Published in Sep 2020: https://www.sandoz.ca/sites/www.sandoz.ca/files/Cefprozil_TAB_Monograph.pdf

    You can read that the med is nephrotoxic.

    My hypothesis from the documentary, the monography, and the Whatsapp convo with the number mentioned in the official FB page.
    Lars overdosed himself accidentally (documentary and Whatsapp convo) with a nephrotoxic antibiotic combined with head injury from the fight (ruptured eardrum makes head injury likely, a perforated eardrum in an assault can cause brain injury per my neurologist). The heat, not drinking enough and the meds he took from his first aid kit (not known when taken contrary to the Cefzil, no info about the med itself nor the dosage), led to kidney injury. Combined with head injury, he got... bingo! A psychotic crisis caused by the bad combo nephrotoxic med in overdose + brain injury.
    In such case, as kidney injury can become permanent, I think that he lives under a new identity not far from where he was last seen. The new identity because of his amnesia combined with ongoing need for chronic life-saving care.
    In such case, he may live either in a group home, psychiatric hospital or foster family for disabled adults.
    So, alive and healthy with his health conditions.
    However, it's even more finding a needle in the haystack because he lives under a new identity and in care.
     
    Last edited: Sep 19, 2021
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  6. Giuc0

    Giuc0 Well-Known Member

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    Out of time to edit, but the Czech monography for Cefzil, published in June 2021, gives similar dosage for the med: https://www.pharmaswiss.cz/data/cefzil/Cefzil_SPC_1662021.pdf

    Cefprozil is out of French, German, Portughese, Spanish... market. It's still authorised by the EMA, European Medicines Agency, but it doesn't mean it's on the all EU countries' market.

    Still on the market in Estonia, Hungaria, Latvia, Lettonia... Greece too from the Greek National Medicines Agency.
    I searched in the national databases as the EMA doesn't update market reviews for Cefprozil since 2018: https://www.ema.europa.eu/en/docume...dicinal-products-psusa/00000605/201712_en.pdf

    And the times Lars took the Cefzil is in the screenshot.

    If 2x500mg at 10pm and one of 500mg at 6am = 1500mg and the monography says max 1000mg/24 hours.
    If it's not an antibiotic overdose, then I don't know what amount is an overdose.
     

    Attached Files:

    Last edited: Sep 19, 2021
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  7. dotr

    dotr Well-Known Member

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    Interesting post, nice to ''see'' you again Giuc0!
     
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  8. Giuc0

    Giuc0 Well-Known Member

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    Ok, I have a question for sleuthers in Germany and Bulgaria.

    Are Poison Control Centers accessible to the public?

    In France, it is, but I didn't know before searching that it was different in Netherlands.

    The European Association of Poisons Centres and Clinical Toxicologists has a link page for Poison Control Centers in Europe, you can find it here: EAPCCT

    I ask because in Netherlands, only doctors can contact Poison Control Center for advice (in Dutch): Home - Nationaal Vergiftigingen Informatie Centrum
    So, BOH contacting them as a member of the public is out of league (got preliminary info on Wikipedia).

    What about Germany and Bulgaria? Here, Wikipedia is not giving any info about access to Poison Control Centers in Germany and no info available for Bulgaria.
     
  9. Giuc0

    Giuc0 Well-Known Member

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    Poison Control Center (in another city because I had bad luck with my nearest) told me that with 1500mg, serious or life-threatening toxicity is of low probability, but it can happen.

    However, toxicologist told me very clearly that Poison Control Center advice should had been sought right away, in the few hours after it was noticed the missing person overdosed herself. Police not making such basic enquiry is already highly abnormal.
     
    Last edited: Sep 20, 2021
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  10. Giuc0

    Giuc0 Well-Known Member

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    Found the list compiled by WHO, all poison control centers in the world for the year 2021: https://cdn.who.int/media/docs/defa...-centre-directory-2021.xlsx?sfvrsn=a9762f89_5 I can't upload their Excel file here.

    However, in Bulgaria, Poison Control Center is only accessible for healthcare professionals. In Germany, anyone can contact them.

    I think that it's a useful resource when available info suggest even a hint of medicine involvement.

    In countries where healthcare professionals only can contact Poison Control Center, a medical doctor can call for more information.

    In countries where it's a service open to the public, any sleuther can contact them.

    I know that this post is peripherial from the topic, but when a case gives a hint of chemical involvement, even taking a med with certain foods, Poison Control Center is a key search.
    If LE doesn't want, sleuthers can.

    @Sillybilly or any admin, is it ok to post this list in the "Resources"? It is a helpful resource for relatives and for sleuthers.

    For Lars, the medicine involvement is so glaring that German LE not even asking any Poison Control Center advice is not coherent.
    In Bulgaria, it's very explainable as only a healthcare professional can contact them.

    Can anyone understanding Bulgarian language check to confirm the "only healthcare professionals can contact them"?
    The list was last updated in 2016 (I know, after Lars disappeared) and in 2021, Poison Control Center modalities may have opened to the public. It would worth a check to see if the information is still up to date in September 2021.

    WHO is a quality website for health information, but the data are not always up to date. I got caught in the Essential Medicines website part for the national lists with "Cefprozil": lists updated in 2011, even Barbados took Cefprozil out of the market since then per Barbados Drug Registry 2018-2020! (the list is available here and meds are listed by their molecule, not their brand name: http://drugservice.gov.bb/fileadmin/user_upload/Products_available_under_MPC_38.pdf)
    Their list is out of date and no update is publicly available.
    But if you look in their registry, Cefprozil is nowhere to be seen, while Barbados is not exactly known for solid State healthcare.
    So, if a poor country took away Cefprozil from their drug registry, there is a very good reason. Especially since Cefprozil is a cheap antibiotic.
     
    Last edited: Sep 20, 2021
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  11. BethAnn777

    BethAnn777 Not well-known, just the way I like it.

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    Lars strange behavior started before he started taking the antibiotic. IMO the possibility that the antibiotic had anything to do with his disappearance is a red herring.
     
  12. Giuc0

    Giuc0 Well-Known Member

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    Not exactly. He took too much of it, which warrants a warning.
    Especially after toxicologist working at Poison Control Center tells you that the police should had sought advice as soon as they started to search (see my above post where I report about my call at my Poison Control Center).

    His symptoms started before, but were magnified by the antibiotic. And it's nephrotoxic, which can magnify psychiatric symptoms you had before.

    I also know by unfortunate experience that when intoxicated with med, your psychiatric symptoms can get much worse than the one you are already experiencing.

    The antibiotic is not the exclusive cause, but you can not dismiss as "a red herring", especially with the overdose.

    The symptoms before don't exclude the antibiotic, especially when taken in accidental overdose.

    I passed the info to German LE at BKA, on the number you can find on this page: BKA - Fahndung nach Personen - MITTANK, Lars Joachim
    Again, nothing classified. The officer with whom I talked to told me textually that he didn't even know of Poison Control Center existance (let alone in Germany), which is very surprising as on any household chemical, the Poison Control Center is a mandatory information. Jaw dropped.
    He told me that for the overdose, he wouldn't even had thought about a contributing factor, let alone looking for monograph (any member of the public can find it on Google if they want, no specific credentials needed). And even without working in the healthcare field, the antibiotic overdose has to be investigated if it hasn't been investigated.
     
    Last edited: Sep 20, 2021
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  13. Giuc0

    Giuc0 Well-Known Member

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    Ok, for the Cefzil toxicology, I am facing a cornelian choice.

    The only English speaking countries where the med is available under princeps and are equipped of a Poison Control Center for the public are South Africa, Zimbabwe and Kenya.

    The Zimbabwe still hasn't replied, I chose them mainly because you can WS them, so no further cost involved for contact.
    You can find them on the Internet with the keywords "datis zimbabwe", nothing secret here. Datis stands for Drug And Toxicology Info Service and is the Poison Control Center official name.
    Warning: their website is down and phone number on FB is much more accurate than what you can find on official source or the Google business result. Contact number on FB is accurate, opening hours are not accurate (their staff is so reduced out of hours that they want only truly urgent calls I think as an explanation).
    Sometimes, FB or social medias are more reliable for contact details for mainstream organisations than even their website, or your embassy in the country.

    On some State organisations websites, especially in poor countries, contact infos are not updated, but they update contact info on one social media only. So, what are WS rules for linking to social medias in this case?

    I'll alert this post because I'm unsure I can link the DATIS FB page. Admin and mods, Datis is the Poison Control Center's name in Zimbabwe, just wanted to make sure it's clearly understandable.

    Since I have had no answer from Zimbabwe, I have two options. Both are English speaking, both Poison Control Centers are reachable only by phone (no WS number) and both incur very expensive rate per minute even with Skype telephone. Both rates difference is so little that it doesn't make any final difference for the cost I incur (we speak about .01€ difference/minute, on Skype telephone).
    No, I won't use neither my landline nor my cell line, it would be even more expensive!

    Which one is a better choice: South Africa or Kenya?

    Please help with this cornelian choice in my sleuthing.


    Thank you
     
    Last edited: Sep 22, 2021
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  14. Sillybilly

    Sillybilly Administrator Staff Member Administrator

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    Sorry Giuco, we don't have enough Mods and aren't in a position to research and make that call for you. Hopefully you and your fellow members can work out the best course of action through discussion on the thread.
     
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  15. Giuc0

    Giuc0 Well-Known Member

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    All right, Sillybilly.
    But what about the rules about linking SM pages for official orgs when it's the only way to get accurate contact details? Datis website is down and the official orgs give out of date contact details. Only Datis FB give accurate contact details.
    What's the rules about linking to SM in such case?
     
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  16. Giuc0

    Giuc0 Well-Known Member

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    Got Poison Control Center from Bloemfontein (South Africa) by Whatsapp. The head of department herself whatsapped me, mind you!
    Answered late because of loadshedding all day.

    For her, overdosing with the antibiotic, even with a low amount of overdose, can make an adult with brain injury confused.
    So, Lars was already not in his normal state before and the antibiotic overdose worsened his symptoms.

    Also, he could had become worse because of the underlying infection per toxicologist. Mind you!
     
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  17. Giuc0

    Giuc0 Well-Known Member

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    Ok, in need for a MD, nurse or pharmacist to help me.

    I need the screenshots from the toxicology database Afritox. Subscription is free, but is restricted to MDs, nurses and pharmacists, as said on their homepage
    Source: AfriTox

    Since the cefprozil (prescribed under the brand name Cefzil, 500mg tablets) is out of the European toxicology database per French Poison Control Center, I already called Poison Control Center at Bloemfontein and I found no one able to help me for getting the info at the source (our Consular Counsellors who are MDs in the area don't practice as they are not registered), I'd like a verifed professional who is a MD, nurse or pharmacist to help me with this stuff.

    The brand name for Afritox is Auroprozil.


    It can help the family.


    Regards
     
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  18. Bit of hope

    Bit of hope Have a nice day!

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    Hi sweetie...see you struggling with this...is this going to bring Lars back...or give an explanation where he ended up/can be found? IMO whatever happened with him.....where is he?...why is he or his body never found....? Do you think the details about his medication is going to make a difference? I'm sorry....I don't believe this is going to be the solution in finding him.
     
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  19. annpats

    annpats Well-Known Member

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    ....and surely any overdose of anti-biotic would make him vomit, have dizziness, feeling faint FIRST etc.
    I doubt just taking an extra 500mg would blow him into immediate psychiatric meltdown. The overdose wasn't that high, and if on the rare off-chance it was affecting him badly, he'd probably be vomiting, diarrhoea and losing consciousness first.

    Oh, and the reason the police or doctors didn't call a poison control centre? Because it's Bulgaria. The doctors are low-paid and don't care about their jobs enough. It's true. They'll do the basics, but won't go out of their way. Lars spoke no Bulgarian, so they didn't really want to bother too much. Just patch him up with tablets or something, and move on to the next patients. There is no responsibility like there is in many other countries. Even more so for a young foreign guy who'll be flying home in a few days.....
     
    Last edited: Oct 17, 2021 at 6:43 PM
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  20. Giuc0

    Giuc0 Well-Known Member

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    Yes because side effects can become permanent. My theory is that Lars is alive but needs ongoing care for the sequelaes, so living under a new identity not far from where he was last seen. See Latulip case.
    I believe that Lars' case is similar to Latulip.
    ETA: Latulip case: Man Missing 30 Years Helps Solve His Own Disappearance

    By knowing more about its effects, we can target the research. Ex: nephrotoxic meds -> search among kidney patients association in the area where last seen etc...
    I don't know if I made myself understand.

    Not necessarily, and that's the problem.
    I have psych sequelaes from congenital brain injury, and even a small intoxication leads to a full blown psychiatric meltdown straight away. Including somatic only meds.
    What you say is mostly true, but with strong brain/psych symptoms before taking the med and the assault, I say that the psychiatric meltdown straight away is to be kept until otherwise proven.

    ETA: my psychiatrist dx me as slow metaboliser of meds 2-3 years ago, but most patients don't know that they are slow metaboliser.
    So, when pt has intense side effect with a very low dose, it can easily baffle doctors. Also, per my psychiatrist, slow metabolisers are more at risk to get serious atypical side effects even at a low dose.

    Actually, he had psych symptoms before and highly likely to have brain injury after the assault.
    In such case, a small overdose can lead to confusion without the physical effects: you get the psych meltdown straight away.
    If there wasn't any hint of brain/psych involvement before, I'd completely agree with you.
    I intoxicated myself accidentally with antihistamine and steroids, it was a small overdose and I got only the full blown psychiatric meltdown. It was treatable at home, fortunately.
    A small overdose with brain injury can lead to full blown psych symptoms right away unfortunately. Yes, a small overdose can have such effects straight away.
    It depends how you metabolise meds. Slow metabolisers have more side effects at a very small dosage, and the side effects can be very serious with even a below dosage recommended.
    That's why I think that a small overdose as it was can have led to a full blown psychiatric meltdown.

    What is inexcusable here is that German police didn't even seek advice to Poison Control Center. Bulgaria police, let go of it.
    But German police can and should have done it as in Germany, it's a general public service. Heck, it can be done by a citizen without any specific professional credentials!!
    In Bulgaria, only healthcare professionals can access to Poison Control Center. See list from the WHO I linked earlier.
    What's baffling is that LE for homicides in Germany (BKA, as I posted earlier) didn't even know about Poison Control Center existance.
    I find it even more inexcusable for German police: they could had called Poison Control in Germany and send the info in Bulgaria. They don't need specific powers for asking Poison Control opinion: they call their nearest center and say "I have a mother reporting to me that son took 1500mg of Cefzil, 2 at 10pm the night before and one at 6am, and she reports that her son did X, Y, Z which is very out of son's character. What's your opinion?" After the call, they report the info to LE in Bulgaria.
    If I can call Poison Control Center in Germany as a citizen, there is no reason why German police can not do it themselves!!!! They don't even need to involve forensics at all for such call.

    Since the med is now out of the market in most EU countries, I did exactly this with South Africa and got the answer by Whatsapp. I got even info which I didn't know, the infection leading to a full blown psychiatric meltdown, and from Bloemfontein Poison Control Center headperson.
    And I'm only a member of the public, mind you!
    Yes, I did what German police should have done as soon as Sandra reported her son missing in Germany. I'm still baffled by citizens having to do this job, and complicated because med is now out of most EU countries, when it is German LE's job!
    Then, I reported everything to the Whatsapp number the family put in place and by email.
    If I could do it, German police could had done it in 2014 and without as much hassle as nowadays when med is out of the market. Geeee!
    I am still baffled about this one.
     
    Last edited: Oct 19, 2021 at 4:48 AM
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