“I'm not great at the advice. Can I interest you in a sarcastic comment?”

This is what ‘Friends’ actor Matthew Perry’s character Chandler Bing was known for. He was known for being funny. However, he had his own struggles in his personal life and those struggles were acute depression. He was treating it with ketamine infusion therapy which is legal in the US and the UK.

What is Ketamine infusion therapy?

Ketamine is an anaesthetic used to treat depression, anxiety and pain under supervised and controlled medical settings. However, it does have its side effects, which can lead to distortion of sight, sound and time. It can also produce calming and relaxing effects.

Ketamine increases a person’s heart rate and blood pressure. If overdosed, it can leave users confused and agitated and can cause them to hurt themselves without even realising it. It can also lead to liver damage and bladder problems.

However, when used in moderation and under the supervision of medical doctors, it can treat depression where traditional antidepressants have failed.

Prof Rupert McShane, a University of Oxford psychiatrist who runs an NHS ketamine treatment clinic told BBC that ketamine “probably turns off the area of the brain that is involved in disappointment.”

Can Ketamine Infusion Therapy Kill Someone?

In simple terms, it cannot, be if the dosage is given in a controlled setting and as prescribed. Ketamine infusion therapy uses drugs in small doses than those used for anaesthesia. It acts faster than traditional anti-depressants, but the effects also wear off way quickly. Which is why it is important to monitor patients’ mental state for relapsing back into depression and discouraging them from overdosing on it.

There are ways of giving people ketamine. One of the ways is through “infusing”, which means to use an IV drip. However, injections, nasal sprays and capsules are also methods used to give people ketamine.

Since the dosage of ketamine used in the infusion treatment is small, it being the reason of actor Perry’s death was ruled out. The medical examiner also noted that Perry’s last ketamine infusion therapy session happened more than a week before his death, which means by the time he had died, it must have worn off.

So, What Happened To Perry?

Though Perry’s last session was more than a week before, his post-mortem showed that his blood contained a high concentration of ketamine. He had died of the “acute effects” of ketamine.

If it was not his session, then how did he get ketamine?

Prosecutors alleged that his assistant gave him at least 27 shots of ketamine in four days before his death, reported BBC.

Perry has been open about his personal struggles and this is what the doctors and dealers used against him. Martin Estrada, the US attorney for California’s Central District told the BBC that people took advantage of his condition. They charged him 165 times more than what vials of ketamine cost.

Names that have come up include Dr Salvador Plasencia, drug dealers “Ketamine Queen” aka Jasveen Sangha and Eric Fleming, and Perry’s live-in assistant Kenneth Iwamasa.

Who Are These Names And What Did They Do?

Ketamine Queen or Sangha supplied drugs that led to Perry’s death. Her home was a “drug-selling emporium,” said Estrada. More than 80 vials of ketamine, and thousands of pills including methamphetamine, cocaine and Xanax were allegedly found in her house known as the “Sangha Stash House.”

Sangha is known to deal with high-end celebs and was a “major source of supply for ketamine to others as well as Perry,” said Estrada.

Dr Plasencia called Perry a “moron” while charging him $2,000 for vials that cost only $12. He sold Perry 20 vials of ketamine between September and October 2023, costing $55,000.

He was the one who taught Iwamasa, who had no medical knowledge to inject the drug. This is after he knew that “Perry’s ketamine addiction was spiralling out of control,” as per what the investigators told the BBC.

Another dealer Fleming was told by Sangha to “delete all our messages.” While Fleming pleaded guilty to conspiring to distribute drugs unlawfully, he also allegedly messaged Sangha: “Please call...Got more info and want to bounce ideas off you. I’m 90% sure everyone is protected. I never dealt with [Perry] only his assistant. So the assistant was the enabler.”

The court documents also revealed that he asked Sangha on whether the ketamine stays in your system or “is it immediately flushed out.”

Dr Pepper, Bots, Cans

The people who allegedly exploited Perry used coded language for ketamine and called it “Dr Pepper”, “bots”, or “cans.”

Selling overpriced drugs, taking advantage of Perry’s mental condition and falsifying medical records to make the drugs given to him look legitimate by Dr Plasencia is what took Perry’s life.

Iwamasa is said to have administered more than 20 shots of ketamine and three on the day Perry died. Whereas ketamine is only administered by a physician. Authorities also found that weeks before Perry’s death, Dr Plasencia allegedly bought 10 vials of ketamine and intended to sell to Perry.

He also injected Perry with a large dose, two days later. This caused him to “freeze up” and spiked his blood pressure.

When I Die, I Want Helping Others To Be The First Thing That’s Mentioned

Perry had always been open about his drug addictions, struggles with alcohol and his depression. He said that his openness would help others who are also struggling and wanted to be remembered by his quote which also is on the homepage of the Mattew Perry Foundation that helps others struggling with the disease of addiction: “When I die, I want helping others to be the first thing that’s mentioned.”

Five arrests have been made in the case so far.

English singer-songwriter Robbie Williams has opened up about being diagnosed with “a little bit of autism” and shared his struggles with intrusive thoughts.

The 52-year-old singer revealed that he had earlier been diagnosed with ADHD, as well as Tourette’s syndrome, the Daily Mail reported.

Robbie Williams' Autism Diagnosis

Speaking at the launch of his clothing brand Hopeium at Flannels, Williams said his autism diagnosis has helped explain some of his behaviors.

“I have ADHD and I just found out I have a bit of autism as well, which I actually f*****g love because it explains so much,” he said.

The British pop icon said he now sees the diagnosis as an explanation for “all the weird” things he does. He also described how ADHD affects his ability to concentrate.

“With the ADHD you can completely and utterly concentrate on something 1000 per cent, but with absolutely everything else, you just cannot do it. Ask my kids,” he said.

The singer said he is “completely and utterly obsessed with creating images and making funny things”.

'My Brain Is Incredibly Creative'

Williams, who has won a record 18 BRIT Awards, said creativity helps him redirect his thoughts and avoid focusing on things that make him panic or feel scared.

“My brain is incredibly creative, and it can be creative about everything in the world that you panic or are scared about,” he said.

He gave the example of sitting on a plane and having an intrusive thought about possessing telekinetic powers and causing the plane to crash.

He said he has learned to “train my brain to do something better” rather than focusing on worrying thoughts.

What Is Autism?

Autism is a neurodevelopmental condition that can affect communication, social interaction and behavior. It is a spectrum, meaning symptoms and their severity can vary widely between individuals.

Common characteristics can include repetitive behaviors or interests, difficulty with changes in routine and challenges in social situations.

Robbie Williams on Tourette's Syndrome

Williams has also previously spoken about being diagnosed with Tourette’s syndrome. In a recent podcast, he said he had realized that some of the intrusive thoughts he experiences may be connected to Tourette’s, although he does not experience the typical outward tics.

“I've just realized that I have Tourette's, but they don't come out. They are intrusive thoughts that happen,” Williams said.

He also spoke about struggling to fully take in the reaction of audiences, despite performing in front of large crowds.

Williams Diagnosed With ADHD Thrice

Williams has said he was diagnosed with ADHD three times because he “forgot” that he had previously been told he had the condition. He first recalled being diagnosed around 2006 after recognizing ADHD symptoms while reading about the condition online.

After his diagnosis, he said he began taking a large number of tablets in the hope that they would “fix” him. He later said his substance misuse escalated, including crushing and snorting the pills.

Williams has faced several addictions and has had multiple stays in rehabilitation since rising to fame in the early 1990s.

What Is ADHD?

ADHD is a neurodevelopmental condition that can involve persistent difficulties with attention, organization and impulse control.

Symptoms can include being easily distracted, forgetfulness, losing things and difficulty maintaining concentration. Some people may also experience restlessness and impulsive behavior.

A 40-year-old woman developed a rare and potentially life-threatening “flesh-eating” infection of the genital and perineal region about a week after shaving her bikini line and an application of herbal preparation.

The woman, a mother of four with a BMI of 39 kg/m², was diagnosed with Fournier gangrene, a severe form of necrotizing fasciitis that can rapidly destroy soft tissue around the genitals and perineum.

She spent 77 days in hospital undergoing treatment, wound care and reconstruction. Complete wound healing was documented by Day 121, reported doctors from King Saud University in Riyadh, Saudi Arabia, in the American Journal of Case Reports.

Severe Pain and Swelling

The woman presented with worsening pain and swelling of the left labia that had spread toward the area above the pubic bone. She also experienced vomiting and lower abdominal pain.

About a week before admission, she had undergone perineal shaving and had a herbal preparation applied to her vulva by an alternative practitioner. She had not used antibiotics or other topical treatments before seeking medical care.

On admission, her heart rate was elevated at 140 beats per minute, although she had no fever and her blood pressure remained normal. Examination showed marked tenderness and swelling, while laboratory tests indicated a significant inflammatory response.

Samples taken from the infected wound grew several different types of bacteria (E. coli, Klebsiella pneumoniae, and Enterobacter cloacae). However, no bacteria were detected in her bloodstream.

Multiple Surgeries

After doctors diagnosed her with Fournier gangrene, they performed urgent surgical debridement to remove the affected tissue.

She subsequently underwent multiple surgical re-explorations and negative-pressure wound therapy.

She was initially given broad-spectrum antibiotics, and later amoxicillin-clavulanate.

What Is Fournier Gangrene?

Fournier gangrene is a rare, rapidly progressive form of necrotizing fasciitis affecting the perineum and external genitalia. It is often described as a “flesh-eating” infection because bacteria can cause rapid destruction of skin and underlying soft tissue.

The condition is much more common in men, but women can also develop it. Reported male-to-female ratios range from 10:1 to 40:1.

Risk factors include diabetes, obesity, immunosuppression, malnutrition, peripheral vascular disease, kidney disease, malignancy and other serious underlying conditions. However, Fournier gangrene can also occur in people without the classic risk factors.

Local trauma, disruption of the skin barrier and invasive or cosmetic procedures can potentially provide an entry point for infection.

Why Fournier Gangrene Can Be Missed in Women

The researchers noted that Fournier gangrene may be underrecognized in women, partly because its symptoms can initially resemble a gynecological condition.

Early symptoms may include severe pain, swelling, redness and tenderness around the genital or perineal area. As the infection progresses, tissue destruction, skin discoloration, blisters or systemic signs of severe infection may develop.

"While men are more frequently affected, women should not be assumed to be at low risk. Severe or rapidly worsening pain and swelling around the genital or perineal region, particularly when accompanied by systemic symptoms, warrants urgent medical evaluation," the team said.

Treatment generally requires emergency surgical removal of dead and infected tissue along with broad-spectrum antibiotics and intensive supportive care. Survivors may require multiple operations, prolonged hospitalisation and complex wound management.

How Serious Is Fournier Gangrene?

Fournier gangrene is a medical emergency. Although rare, it can progress rapidly and become fatal if treatment is delayed.

The condition has historically been associated with high mortality, with risk increasing when diagnosis and surgical treatment are delayed.

A 62-year-old man in Australia died after his urgent heart surgery was cancelled twice. A state coroner later found that failures in an overworked health system contributed to his death.

Petar Josipovic had been diagnosed with moderate-to-severe aortic regurgitation and coronary artery disease. He was placed on the cardiothoracic surgery waiting list at Royal Adelaide Hospital as a Category 1 patient, meaning his surgery was expected to take place within 30 days.

However, his operation, initially scheduled for August 14, 2023, was cancelled twice to make room for higher-priority emergency patients. It was eventually rescheduled for August 25.

The day before his surgery, Josipovic was rushed to the emergency department after his condition deteriorated and suffered a cardiac arrest.

Doctors performed an emergency aortic valve replacement and coronary artery bypass surgery, but he developed severe complications and died about three weeks later in the ICU.

Coroner Says His Death Was Linked To Failures In Healthcare System

South Australian State Coroner David Whittle found that Josipovic's death was potentially preventable and called for a sweeping independent review of how cardiac surgery patients are assessed, listed and managed while waiting for operations.

The coroner, however, did not attribute the repeated cancellations to individual negligence. “I do not make any finding that the decisions that led to the cancellations were the result of ill-will or lack of due care,” Whittle said.

Instead, he said a health system under immense pressure was bound to have systemic failures. He also said that staff were unable to recognise the extent of the patient's deterioration before it was too late.

Also read: Stopping Statins After 75 May Not Raise Death Risk In Low-Risk Adults: The Lancet Study

Why Was An Urgent Cardio Surgery Repeatedly Delayed?

The inquest heard that reduced intensive care capacity had put additional pressure on the cardiothoracic service. ICU capacity reportedly fell from 24 beds to 16 following the move to the new hospital site, meaning urgent procedures could be postponed when beds were unavailable.

Josipovic's case also highlighted the problem of keeping track of patients whose condition worsens while they remain on surgical waiting lists.

The coroner noted that Josipovic had been advised to attend the emergency department on occasions but did not do so. This meant clinicians did not have the opportunity to physically reassess his condition and fully appreciate how much his risk had increased.

Also read: More Indians Face Twin Burden of Hypertension and Diabetes After 40: Why Preventive Healthcare Is Important

Coroner Recommended Urgent Changes

Whittle recommended an independent external review of cardiothoracic surgical listing practices, covering the patient's entire medical history from referral and assessment to waiting-list management and hospital resources.

He also called for standard guidelines across South Australia's health networks so staff know exactly what advice to provide when patients waiting for surgery report that their condition is worsening.

The case has renewed concerns about what happens when hospitals have to balance urgent operations against limited beds and resources.

The case has also highlighted an important issue. For patients waiting for time-sensitive procedures, a delay is not always simply a longer wait. In some cases, the patient's clinical condition can change while they remain on the list