Our heartfelt sympathies to his family.

From our pal, Mike Weatherford, at the Review-Journal:

Impressionist Danny Gans’ death was accidental and the cause was hydromorphone toxicity due to chronic pain syndrome, Coroner Mike Murphy announced this afternoon.

Hydromorphone is a synthetic opiate more commonly known as Dilaudid.

“This was not drug abuse,” Murphy said. “What I’m trying to be clear about is, we have an issue involving Mr. Gans’ health and the hydromorphone, and as a result of a combination of those issues, Mr. Gans succumbed to his health condition.”

Dilaudid was “a factor in exacerbating those risks” of his pre-existing conditions, hypertensive cardiovascular disease and polycythemia, a thickening of the red blood cells often described as “the opposite of anemia.”

Dilaudid's analgesic potency is from two to eight times that of morphine, but it is shorter-acting and produces more sedation than morphine, according to the Drug Enforcement Administration.

Murphy said the coroner’s office has met with the family.

“We are trying to respect their privacy and treat them appropriately as we deal with all families... They’ve been very good to work with.”

Gans had shoulder surgery in November, days after his show closed at The Mirage, and another “clean-up” procedure in March, according to his manager, Chip Lightman.

“Could they have given him that during his recovery?” Lightman mused, saying he did not know one way or another. “I don’t know where he would have gotten (Dilaudid) from but from his doctor, that’s all I could figure.”

However, Lightman said, “It would just be very odd for Danny to take too much pain medicine because it would dry his vocal chords out. He wouldn’t really do that because it would hurt his voice.”

Lightman also said Gans “was having terrible pain in his shoulder,” related to a chronic condition that dated back to another surgery in 2006. Gans had the November surgery “immediately” after The Mirage show closed “so he could recuperate before we started rehearsals” for the new Wynn showcase that opened in February.

“Then he was in terrible pain again in March from the shoulder stuff, so they went in again and got rid of some scar tissue and did some clean-up from the original surgery.”

Gans played golf the day before he died.

“I know playing golf exasperated (the pain),” Lightman said. “I know he was feeling pretty good (but) he was exhausted from not sleeping the night before. Then he had his massage that he usually has on Thursday (April 30) then went to take a nap. Period. Nothing out of the ordinary.”

Gans discussed some of his ongoing physical issues in a February 2006 interview, when he was about to reopen his show at The Mirage after a three-month break for surgeries on his right rotator cuff and left hand.

As he described it at the time, the cumulative wear and tear from years of baseball, golf, martial arts and the physicality of his nightly show had caught up to him, requiring a three-month break from his show.

“I had a lot of bone spurs in there (the shoulder) and a lot of scar tissue from hurting it — little tears and I continued to perform. Maybe it would take four to six weeks to fix the tear that maybe I started three years ago. I said, ‘Oh, you know, I’ll just take more Tylenol and I’ll be OK,” Gans said in 2006.

“And sure enough it went away, but what happened was, Mother Nature fixed it in its own way with scar tissue. And now the muscle is kind of detoured in a different way....

“And then I would hurt it again. I’d swing a golf club or something: ‘Ow! OK, I’ll take more Motrin tonight. I’ve got a show, I don’t want to miss.’ Because I had that one period in 2003, I missed a ton.

“That was a really bad year. I lost both my parents, I had an automobile accident, it was just a really rough time.”

During the 2006 interview, he said, “Right now I can’t raise my arm up over my head yet. So I had to cut a couple of things in the show where I used to use my right arm, now I use my left arm.”

Gans played one season of minor-league baseball before an injured Achilles tendon redirected him into show business. Baseball “was the start of it,” he said in 2006. “Lifting weights, playing golf, and I studied martial arts for about five years. Most of that was before I came to Vegas.

“Finally that one little straw that broke the camel’s back finally happened,” he said of the shoulder injury. “I knew I had to take the time off. I think I did something in the gym. The worse my shoulder got and the more doctors I saw about it, (they said), ‘You’re going to need some significant time off. In order to delay that, you need to get into the gym and strengthen the muscles around it.’ ”

Gans said that was a tough time “when I said, ‘OK, I have to take this time off.’ We needed to give The Mirage 120 days notice and that’s when my shoulder was at its worst.”

After he started performing again, Gans said it was difficult to rest his hand properly.

“The tough thing with a hand surgery is, unlike a knee or a shoulder or something, you can rest those. With your hand, it’s tough to give it a break. You can’t really do it. You can ice it, but as soon as I take the ice away and go grab something, then I’m using it. ... Always after the show, I put an ice pack on my back and sit down at the table and write all my notes about the show.”

Gans, 52, died early May 1 at his Henderson home after having trouble breathing. His wife called 911, but paramedics couldn’t revive the entertainer.

The coroner’s office performed an autopsy later that day, but officials waited for toxicology and tissue tests from an independent laboratory before making their final determination.

From our pal, Mary Manning at the Las Vegas Sun:

Las Vegas entertainer Danny Gans' death was an accident and underlying health problems were a factor, the Clark County coroner said Tuesday.

Chronic pain syndrome treated by a pain medication contributed to the death of Daniel Davies Gans. High blood pressure also was a factor, as well as a red blood cell disorder.

Clark County Coroner Michael Murphy said Gans had a toxic reaction to hydromorphone, which is a common pain medication such as Dilaudid, in addition to other physical causes, he said.

Murphy would not release the amount of the drug found in Gans' blood.

"That's a quality of care issue that this office does not address," he said.

The coroner wouldn’t say whether Gans had a prescription for the painkiller. "This is not an issue of drug abuse," he said.

Murphy wouldn’t release the name of Gans' physician.

The coroner's investigation indicated that Gans had hypertensive cardiovascular disease, which causes high blood pressure, thickens the walls of the heart and can create conditions that cause heart problems.

In addition, Gans had polycythemia, a condition that produces more red blood cells than necessary and thickens the blood. The condition is sometimes known as the opposite of anemia, where there are too few red blood cells.

Murphy released Gans' cause of death during a Tuesday afternoon news conference. He said his office reached the conclusion earlier Tuesday.

"We send heartfelt sympathy to the Gans family," Murphy said. The coroner said he had spoken to the family before the news conference.

Murphy said the coroner's office can rule a death one of five different ways: natural, accidental, homicide, suicide and undetermined.

Dr. Gary Telgenhoff, a medical examiner in the coroner's office, said Gans' underlying health conditions already were serious upon his death. Telgenhoff said he had not spoken to Gans' physician during his examination.

Gans, 52, was the headliner at the Encore resort. The singer, actor and impressionist died in his sleep early in the morning of May 1 at his Henderson home. Although the time of death is listed as 7:35 a.m., Murphy explained that a certified health care professional must pronounce a death before it becomes official.

Gans' wife, Julie, found him about 3:44 a.m. May 1. She called 911 and said he was having trouble breathing. Paramedics arrived seven minutes later. He never was alone from the time his wife found him until he was pronounced dead, Murphy said.

After Gans' death, the coroner sent tissue and microscopic samples for lab testing and it took almost six weeks to receive the results, Murphy said.

Over the years, Gans had been billed as "The Man of Many Voices." Gans was named Las Vegas Entertainer of the Year a dozen times.

Gans wasn't always an entertainer. He played minor league baseball until he suffered an injury. He eventually performed in Las Vegas at the Stratosphere, the Rio and the Mirage before going to the Encore, where he opened Feb. 10 in the 1,500-seat Encore Theater.

After his death the Encore posted Gans’ picture on the resort's marquee with the message: "Our friend forever. Danny Gans. 1952 2009."