“My right arm is numb and I can’t use my fingers,” she said. “Do you think that’s okay?”
“Probably not. When did it start?”
“Since I woke up at six a.m.”
It was noon. And her speech was slightly slurred…but she was completely coherent.
I was on the treadmill. I paused my guilty-pleasure TV show and came to an abrupt stop to do an emergency over-the-phone consult. At first it sounded like she might have a cubital tunnel syndrome (compression of the ulnar nerve at the elbow–the “funnybone’) but as she described her symptoms, it started to sound like something else.
Normally when your arm or leg “goes to sleep,” when you’re sleeping, it wakes you up. We’ve all had that happen–you wake up and your arm feels dead, but you shake it out and it’s fine in a few minutes. But if you’ve had too much to drink, you may sleep harder than usual, and you could sleep through your body’s natural alarm system. This could cause a compromise of blood supply to the nerves and muscles in your arm, which could lead to temporary–or, depending on how long it lasts–permanent paralysis and tissue damage. This is called a compartment syndrome.
But that couldn’t be. That only happens to people who drink too much–I’ve known Kelly for six years and I’ve never seen her drink. She doesn’t even like the taste of alcohol and she’s allergic to the sulfites in wine. Actually, she’s one of the nerdiest people I know–nothing like her iconic character, “Kimber Henry.” Of course, I mean that in the nicest way
I told her to meet me in the office immediately. On my way driving in–still in my sweaty LuLu Lemons—I went through the differential diagnosis in my head, wondering how on earth I was going to tell my friend she might be having a stroke or possibly developing the first signs of Multiple Sclerosis. She’s so young and vibrant and talented–what a tragedy!
She walked in to my waiting room looking like a million bucks as usual, but she was in a panic. While I examined her arm, which was slightly swollen but otherwise fine, I noticed that she was still talking funny. Trying not to seem obvious because I didn’t want her to freak out, I checked for other classic stroke symptoms. Was one of her pupils more dilated than theother? Was the left corner of her mouth drooping?
The neurologic exam involves checking to make sure the patient’s tongue doesn’t deviate to one side when they stick it out because this would mean imbalance of muscle function, and possible nerve damage. All I noticed was that Kelly’s tongue was either very swollen, or I’d never before noticed how abnormally large it was. When I asked her about it, she said, “Yeah, I don’t drink wine because this is what happens. But I did go to a birthday party last night…”
Apparently, Kelly had decided to go crazy and drink to a toast the night before.
“So what was in the drink?”
“I don’t know…prosecco…”
I started laughing and when she asked me what was so funny, I said, “Why didn’t you tell me this morning that you decided for the first time in years to have a drink? And how did you not know prosecco is wine? That could explain the allergic reaction you’re having with your swollen tongue.”
I explained that the alcohol probably made her sleep deeper than usual, and that she had developed a mild compartment syndrome which appeared to be improving. I consulted with my colleagues at Cedars’ Emergency Room. (I didn’t want to tell her, but I’d never seen anything like this before.) The Emergency Room Physician laughed and said, “I wish I could tell you about all the rock stars that come in here with the same problem.”
But as all of her close friends know, Kelly is no partying rock star. She’s usually the parental supervisor, the designated driver. And the one time she decides to have a fruity island drink (we’re laughing as we write this) she winds up with a super-sized tongue and a compartment syndrome. That’ll teach her.
The ER Physician said that with the rate of improvement she’d been having, her symptoms should be completely resolved within the next twenty-four hours. First level treatment is high dose ibuprofen (600 mg., three times a day). But this is not medical advice! If you wake up with signs or symptoms of a compartment syndrome, you need to go to your nearest emergency room and be treated by a physician. But, like I said, I learned something…I didn’t realize that this could happen to someone who crashes out just a little too deeply, from drinking just a little more than their body is used to—in this case, drinking anything at all! Take note: You are especially prone to it happening if you sleep with your arm above your head.
Fraxel update, day five: neck feels a bit dry, but looks back to normal, and the skin texture is definitely better…