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0 9 - 0 2 - 2 0 0 7 Smith plagued by health issues
Julian Kesner
NEW YORK - Anna Nicole Smith [Wikipedia] had a sordid history of massive weight swings, dubious diet pills and drug and alcohol abuse - and experts speculate at least some, if not all of these factors, contributed to her death at age 39.
An autopsy is set for Friday to determine
Smith was apparently under the care of a private nurse, which suggests she may have been taking several medications that required monitoring. Witnesses at the Florida hotel where she died reported that earlier in the week she needed help standing up and sitting down.
"She was completely out of it," Ron Hanson, a 57-year-old retiree, told the Orlando Sentinel in a story posted on its Web site last night. She was also hospitalized with pneumonia in late October.
"The suspicion is that there's cardiac failure," said Dr. Lawrence Kobilinsky, a forensic science professor at John Jay College of Criminal Justice. "The obvious speculation is there was some sort of overdose of one drug, or the use of more than one drug with synergistic effects."
However, the role of diet pills "is unlikely," Kobilinsky said.
"Even if she had double or triple the dosage, I doubt it would kill her," he said.
Manhattan cardiologist Dr. Nieca Goldberg agreed, saying that she hasn't heard of such situations since the diet pill ingredient ephedra was banned in 2003. A toxicology report on her bloodstream could take up to a week.
Smith battled drugs and alcohol much of her life.
CNN's Larry King said Thursday that Smith once showed up to his set intoxicated, and the buxom starlet reportedly did at least one stint at the Betty Ford Clinic more than a decade ago.
Smith's husband, Howard K. Stern, has been accused of providing methadone to her son Daniel, who overdosed on that drug and anti-depressants Zoloft and Lexapro in the Bahamas in September. Stern has denied the charge.
In November, Smith's mother, Virgie Arthur, insisted her daughter was using illicit drugs and blamed her for Daniel's death.
"She has had drugs with her since she was a model . . . of every kind," Arthur told Dr. Keith Ablow on his syndicated TV show. "She really is a good person when she is not on drugs. But she lives on drugs now."
Smith repeatedly denied abusing drugs, but one issue without debate was the 5-foot-11 blond's wild weight swings.
In 1992, a year before becoming Playboy's Playmate of the Year, Smith reportedly weighed about 140 pounds.
She ballooned to 224 pounds a few years later but then claimed to drop 69 pounds in eight months using TrimSpa, an unregulated diet pill for which she served as spokesmodel. TrimSpa recently was fined millions for false advertising. [Anna Nicole Smith, TrimSpa sued over diet ads - AP Feb. 7, 2007]
"There have been studies in women that show repeated weight loss gain increases one's risk of cardiovascular disease, but it doesn't necessarily indicate cardiac arrest," said Goldberg, author of "The Women's Healthy Heart Program."
Women with eating disorders are also more prone to life-threatening heart problems, she added.
2 8 - 0 3 - 2 0 0 7 Officials: Smith's death caused by overdose
CNN
FORT LAUDERDALE, Florida -- An accidental overdose of prescription drugs killed former reality TV star and Playboy playmate Anna Nicole Smith, Seminole tribal police Chief Charlie Tiger said Monday.
Tiger said the case was now closed.
"We are convinced, based on extensive review of the evidence, that this case is an accidental overdose with no other criminal element present," Tiger said at a news conference announcing Smith's autopsy results.
Lilly Ann Sanchez, Howard K. Stern's attorney, read a statement from her client Monday afternoon and called the death a tragic accident. "At no time was there any indication of wrongdoing,
Sanchez accused the media of "outrageous speculation" when reporting on Smith's death.
"Howard does not feel vindicated... He has lost the most important person in his life," the attorney said.
Sanchez said Stern 'loved Anna completely.'
"He is deeply saddened and his loss is immense," Sanchez said.
An unresponsive Smith was found February 8 in a room at the Seminole Hard Rock Hotel & Casino near Hollywood, Florida. She was taken to a hospital but was pronounced dead a short time later.
Several prescription medications -- both in Smith's name and that of her partner and lawyer, Stern -- were found in the room.
Joshua Perper, Broward County medical examiner, said prescription and over-the-counter drugs were found in Smith's system, including three antidepressants or antianxiety drugs. Also found in toxicology testing was human growth hormone and chloral hydrate, a sleep medication, Perper said.
"She didn't suffer," he said. "She went to sleep."
Perper said the drugs in Smith's system acted on the respiration and circulation systems and basically shut them down.
The medical examiner said he did not believe that Smith tried to kill herself, as some had suggested, because of the large amount of chloral hydrate remaining in the bottle, and the normal levels of the other medications in her system.
"If they want to kill themselves they usually take a lot," Perper said.
During the course of the autopsy, filed under Smith's legal name of Vickie Lynn Marshall, doctors found evidence that Smith had an abscess in her left buttock that had been perforated by a needle, probably when she took injections of either the growth hormone or vitamin B-12, the medical examiner explained.
The perforation allowed bacteria to get into Smith's blood, which caused a high fever in the days before her death. She was being treated with Tamiflu and Cipro, one an antiviral medication and the other an antibiotic, Perper said.
He also theorized that Smith would have lived had she sought treatment for the fever and infection at a hospital, "because (there) she wouldn't have had the opportunity to take the chloral hydrate."
He said the abscess and a case of flu were contributory causes in Smith's death.
Smith was buried in the Bahamas March 2 next to the grave of her son, Daniel, who died in September, shortly after the birth of her daughter, Dannielynn.
His death was ruled an accidental overdose of three antidepressant medications: methadone, Lexapro and Zoloft, according to forensic pathologist Cyril Wecht, who performed a private autopsy at the request of his mother.
The Royal Bahamas Police Force has said its findings reflected those of the private autopsy, but an inquest is to start March 27 in the Bahamas to determine the official cause of Daniel's death.
Meanwhile, controversy has swirled over the identity of the father of Dannielynn. Stern and two other men have claimed paternity.
In 1994, Smith married 89-year-old Texas oil magnate Howard Marshall II. He died the next year, and until her death, Smith was involved in a legal battle over the inheritance that included a 2006 U.S. Supreme Court ruling.
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[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance."
(Wilmore and Costill) 
