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health Letters

             Our muscles don't warn us when they"re about to self-destruct. Kelly said his legs were killing him, he was right. Mr. Kelly was a prisoner. When Dr. Dajer approached the patient, Mr. Kelly was handcuffed to the side rail of his bed. Prisoners ofter feel the urge for a change of scenery, and a trip to the ER can fit the bill. When Dr. Dajer gripped the thighs of his patient, the patient screamed. Apparently, the pain was horrific. The doctor asked if anybody had hit him. Mr. Kelly replied with a no. Apparently, there was a contest in the jail involving deep knee bends. He won, with an incredible number of 1,134. He stated that whoever won the contest would get extra desert. .
             Mr. Kelly's condition was not quite advanced. His lab work showed that his CPK, the most easily measured muscle enzyme, was an eyepopping 22,000. His thighs, at least on a cellular level, were mincemeat. His urine was also saturated with myoglobin. Kidney function was borderline, and it could go south without warning. Another doctor claimed that Mr. Kelly's kidneys need flushing. The average would take up to 20 liters a day to flush the kidneys. There was also a hefty dose of baking soda added to Mr. Kelly's fluids to neutralize the acid buildup in his blood. At that moment another prisoner rolled in. He was kneading his thighs in a familiar way.
             The next patient was the prisoner who had lost the contest. Mr. Kelly and his rival were both admitted and the ward team was left to manage their controlled flooding. Two days later, the "loser" seemed to be fine. Mr. Kelly on the other hand was still crazy on his CPK. That was worrying. Muscle, like any other tissue in the body, swells when injured. But muscle lives in tough, inelastic fascia envelopes. Too much swelling in muscle can squeeze tiny blood vessels shut. And muscle deprived of blood flow dies. To avoid that problem, the fascia that surrounds the injured muscle must be split open surgically.

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