A 39-year-old real estate executive wasn’t sure the midnight ER trip was necessary. Without it, he might be dead.
By Sandra G. Boodman Sandra G. Boodman Medical reporter and creator of the monthly Medical Mysteries column Email Bio May 25 at 11:00 AM As he climbed into an Uber bound for a Washington emergency room, Michael Zelin remembers thinking he’d be home in a few hours, after a doctor checked out his sore arm and prescribed a painkiller.
Eight days and four surgeries later, Zelin did return home, the fortunate survivor of a highly unusual cascade of events that could have cost him his arm — or even his life. Raizman, whose wife is also a surgeon, is accustomed to nighttime missives. “One of us is usually on call,” he said. So Michael headed to Sibley Memorial Hospital, where Raizman is on staff. Lauren decided she should join him, arriving an hour later after arranging with her mother, who lives nearby, to stay with their children.
“I was sweating and crying and finally said, ‘You have to stop this,’ ” he remembered telling the technician. “I had never been in so much pain in my life.”Shortly before 5 a.m., Lauren called Raizman. Michael had received double doses of morphine, which wasn’t allaying the pain, and was disoriented.
When he arrived in the ER, Raizman performed a compartment pressure measurement test, in which a needle is inserted into a muscle. The result erased any doubt: Michael’s pressure measured 70 mmHg, more than double the reading that indicates acute compartment syndrome. An emergency fasciotomy would be required to relieve the pressure, decrease the swelling and, hopefully, save his arm.
The first operation, which involved making an incision that stretched from Michael’s right palm to his elbow, went well. Raizman said he was hugely relieved to see that the muscle looked healthy. A repeat procedure was scheduled for the next day to clean out and inspect the wound, which would need to be closed.
A few hours after meeting with the infectious disease specialist, Lauren sought out the ICU doctor to tell him something she had forgotten to mention. Several days before Michael’s arm started to hurt, she had been diagnosed with strep throat, a bacterial infection caused by Group A strep. Could the events be related?The following day, tests revealed that the connection seemed likely.
It is a very rare scenario, but one that has been reported previously. In 2008, Ohio doctors published a study of 13 cases over a 57-year-period involving men who developed acute compartment syndrome caused by strep following a nontraumatic injury. Most were previously healthy.
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