You watched Captain Kirk and Mr Spock on Star Trek, and you dreamed of meeting this green-blooded son of a ... Vulcan (in the words of Dr. McCoy) and his brethren, but there you have it. After a two year long cover-up, the truth is out.
These were the romantic daydreams that played in my head when I saw the message flashing on Toronto's CityPulse 24 channel.
It puzzled me why this story was only published now in the media, but the reason is simple: it was only now published in this week's The Lancet, one of the world's oldest peer-reviewed medical magazines.
In October 2005, Dr. Alana Flexman and her colleagues of the St. Paul's Hospital in Vancouver got to treat a somewhat unusual patient. He was a 42-year-old man who had fallen asleep while kneeling. This had caused compartment syndrome in both his legs.
In the body, muscles, nerves and blood vessels are not just thrown together in a bunch. Certain groups of muscles, nerves and blood vessels are held together and separated from others by thin or thick layers of connective tissue called fasciae.
Fasciae are very flexible, but they are not elastic like rubber, (i.e. they do not expand). The space surrounded by a fascia is called a compartment. When swelling occurs inside a compartment, regardless of the reason, the fasciae does not accommodate for this swelling and this leads to pressure increases on the elements (such as muscles, blood and lymph vessels and nerves) in the compartment, resulting in compartment syndrome.
As long as compartment syndrome is discovered in time, and the pressure is relieved without delay, chances for recovery are excellent. If this situation lasts for a long time, the elements in the compartment may die and the limb may have to be amputated.
The surgery, while fairly simple, is nevertheless quite drastic. The fascia surrounding the problematic compartment is cut open in order to relieve pressure. Later on, usually up to 48 hours later, a second surgery is required to close the incisions, sometimes with skin grafts.
When a limb is put under pressure, for example when squatting or kneeling, compartment syndrome can develop. Since the man had fallen asleep while kneeling, this was the direct cause of his compartment syndrome.
While preparing the man for emergency surgery, in the middle of the night no less, they inserted an arterial line into a wrist artery. This is a standard procedure necessary to make it possible to monitor blood pressure during surgery. It is very easy to see if the line insertion procedure has been performed right because the blood flowing through the line will be bright red as a result of oxygenation in the heart.
And then came the shock. The blood flowing through the line wasn't bright red at all. Instead, it was a dark black-green type of colour. Since there was no time to lose, the blood was sent off to the lab to find out what was going on while the surgery went through as planned.
The lab quickly decided that there were no abnormally high levels of methemoglobin in the blood. Methemoglobin occurs when the iron part of hemoglobin is modified in some way leading to difficulties in the absorption of oxygen, a very dangerous condition.
It turned out that the man had high levels of sulfhemoglobin, a potentially deadly condition in which the iron containing part of hemoglobin is combined with a sulfur-containing group. This makes it impossible for the modified hemoglobin to process oxygen. The condition may lead to cyanosis (a blueish discolouration of the skin), but without toxic effects.
Although they cannot prove it, Alana Flexman and her colleagues are speculating that the man was taking higher than normal doses of sumatriptan, a sulfonamide drug used to treat migraine. Sulfonamide drugs can donate a sulfur containing part to hemoglobin, rendering it incapable to process oxygen and giving it a dark green colour. This condition is untreatable. The only way to get rid of the useless hemoglobin is to let nature run its course.
No Mr. Spock, no Vulcans. How awful, and we came so close!
But, regardless: "Live long and prosper!"
Email
Print
Share
