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Always 100%

weights

It felt good to be back to work after such a long layoff. Curtis was unaccustomed to an entire week away from the job, let alone 2 whole months. The winter had been unusually harsh, and even back home in Louisiana it was less than warm. Now, perched atop a cell tower in northern Minnesota, he could not help wishing he was back home. At least there he would be warm.

He had been working for this cell company now for 5 years, and greatly enjoyed the work. The pay was excellent and it afforded Curtis and his new bride a chance to live comfortably. Always physically active, he played sports in high school and enjoyed working out at the gym. Although he had been taking it easy for the last several weeks, he was now back to both his workouts and tower climbing. As he stood on the top of the 400 foot tower, the view was spectacular. He could see clear blue sky all the way to the horizon where the earth seemed to fall away to his left and right.

His work done, Curtis unhooked from the safety point and began the long climb down to the ground. It was cold today, colder than usual even for this place. Once on solid ground, he began loading the equipment into the truck for the drive back to the hotel he would call home for the next few days until his work was done. As he loaded the last of his equipment, he felt a sharp pain is shoulder. Dismissing this as merely tired muscle due to inactivity, he finished loading and drove away. He decided to stop for a late dinner, but when he exited the truck, his leg muscles began to cramp. He tried to steady himself with the truck mirror but filed his arms were extremely weak and he had great difficulty controlling them. It was at this point that he felt an overwhelming wave of nausea.

When the other diners saw him collapse, a call was immediately placed to 911, and an ambulance was soon on scene. As Curtis began to come around he was asked his name, age, and if he had any health conditions or was taking any medication. The paramedics could not understand him; he seemed very confused. The Portable EKG showed a rapid heart rate with arrhythmia. 12 min. later Curtis arrived at the emergency department of the county’s only hospital. Upon inspection, his name was discovered along with his cell phone. A call to “HOME” brought his wife on the line, and after the nurses explanation, she told them that he had no medical issues and was not taking any medication that she knew of. Her biggest concern was that he had fallen, however she knew he was always very careful. She asked the nurse what his condition was, and she answered truthfully that they did not know.

After admission to the ICU, Curtis’s condition grew steadily worse. Simple blood test revealed no known virus or bacteriological infection, despite his fever. As darkness fell, Curtis his condition became critical. The attending physician was convinced of an infection by an unknown viral agent, and treatment with antiviral was begun. By morning, Curtis his wife Megan had called the ICU to check on her husband. Hearing that his condition was deteriorating, and that the doctors seem to be baffled, she contacted her uncle, a clinical epidemiologist.

Dr. Henry Waxler, who seldom responded to anything besides “Hank” was just sitting down to his desk, and his 3rd cup of coffee of the morning when his computer signaled him that he had an e-mail. It was from Megan. She described the situation, and he immediately phoned her. After explaining the occurrences of the previous afternoon, and recounting what the attending physician had said about an unknown virus, Hank put down the phone for a moment and mentally considered the diagnosis. He knew Curtis was from Louisiana, and he knew he was very active and seemingly healthy person. Someone with a compromised immune system might indeed be susceptible to some viral infection, however, what he knew about Curtis did not make him believe this was an accurate diagnosis.

Putting the phone back to his ear, Hank asked Megan a few questions so that he might better get a sense of what had happened. By the time he had finished, he had a good idea of what had gone wrong and how the doctors might want to treat it. Hank began with asking how long Curtis had been on break from work? Megan replied that the winter had been so bad in many of the Midwestern states that the company had given Curtis extended leave. “Had he remained physically active?” Hank asked. Megan replied that he had tried to take it easy, as his job was generally very demanding and required a great deal of travel all over the United States. Had he been going to the gym Hank asked. He recalled the last time he saw Curtis and Megan that Curtis spoke about going to the gym near his home nearly every day. Megan responded that, although he had taken a few months off, he had started working out again. “How intensely?” Hank asked. Megan responded “You know Curtis, everything is 100%.”

With this information Hank had a suggested course of action. Hank asked Megan for the number at the ICU and the name of the attending physician.

When Hank called the ICU, and asked for the attending physician of Curtis’s case, he met with some resistance. Even after explaining his relationship and the fact that he was a clinical epidemiologist, the nurse answering the phone seemed unimpressed. “Please take my name and number and asked if the doctor would mind calling me back” he asked. Eventually Curtis’s physician called back. “I don’t think it’s a virus” Hank told physician, I think you have a case of Rhabdomyolysis.” Interested, the attending physician asked how Hank had gotten that conclusion. Hank explained his theory: a few things lead me to this idea Hank said. First, it has been a very cold winter in the upper Midwest. Curtis is from what can be described as the deep South. His home is perhaps 60° warmer than where he is now. Secondly, his work is extremely physically demanding. He is expected to climb very tall cell towers bringing his equipment with him. The equipment can be quite heavy depending on what he is expecting to do. While it’s been getting colder in the upper Midwest, Curtis has been taking it easy in the South due to the weather. His wife told me that he had been taking it easy for the past few months and is just now started to exercise again. Because Curtis is very physically active person, I am sure his exercise regime is intense. At this point the physician asked what all this had to do with a virus?

Hank explained. A person who is used to being very physically active, who has a physically demanding job, and who was used to a very warm and humid environment, suddenly finds themselves heavily taxed physically while functioning in a very cold and very dry environment may be easily overtax their larger muscles, in Curtis’s case, those of the shoulders and arms and legs. Hank suggested that a blood test for creatine kinase, and checking for extremely high levels of potassium in the blood would be a quick way to rule out rhabdomyolysis.

As Curtis was already being treated with IV fluids, adding electrolytes was a simple procedure. Blood tests were conducted and high levels of creatine kinase were discovered. Another test showed extremely high levels of potassium which explains the arrhythmia that Curtis had when the paramedics had brought him to the ER. Hank suggested diagnosis to protect Curtis’s kidneys and other organs, and management of electrolyte abnormalities to protect his as heart.

By 5 PM the day after Curtis’ admission to the ICU his appetite returned. By 8 PM he was asking if you could be released. By 8 AM the following morning he was able to be discharged and drove back to the hotel. It may be interesting to note that no virus was ever discovered.

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