A few months after the stroke, the man was in a coma. What was wrong?

Eventually, he agreed to see Dr. Richard Kaufman, their primary care physician. Kaufman was shocked to see the man’s face, how the skin of his face was folded and hanging as if air had come out of his cheek. He lost about 40 pounds. He is struggling to walk a few steps to the test table. His right side, which had been weakened by his stroke, now matched the weakness on his left side. Her stroke did this. Something else was going on. Kaufman ordered some preliminary blood tests to see where the problem might be. Those results sent the couple to the emergency room.

In the afternoon when on-duty hospital doctor Osama Kandalaft finds the couple. It was December 2021, and the ER Covid case was bursting with a new wave. The patient was on a stretcher in the hallway. His wife sat on a stool next to him. Before meeting the man, Kandalaft reviewed the results of tests performed on the ER that his kidneys were in poor condition.

Kandalaft saw a pattern in other labs that he recognized. One study found the presence of large amounts of blood in the urine of men. And yet when the urine was examined under a microscope, no blood was seen. Because it was not blood; It is a hemoglobin cousin, myoglobin, the oxygen-carrying component of muscle that is released into the bloodstream after injury. Extensive muscle damage can certainly explain a person’s weakness. Moreover, he was taking a cholesterol-lowering drug, a statin called rosuvastatin, which is known by some to be the cause of muscle injury among those taking it. Kandalaft was not sure if the statin could cause problems in the patient’s swallowing. Still, he will stick to the drug and order a test to see creatine kinase, another protein excreted by injured muscle.

Physicians often use O’Keefe’s razor principle, which was uttered by the 14th-century O’Keefe philosopher William, who claimed that the simplest explanation of any phenomenon was probably correct. A single, elegant explanation of pain is often welcomed by both physicians and patients more than the contemporary principle, which has been blamed by 20th-century physician John Hikam, is that “patients can be as good as they can be.” But in Kandalaft’s experience, Hikam’s complexity often fits well. Especially with a patient who was 82 years old and had diabetes and heart disease and had a recent stroke.

The patient and his wife have spent most of the night in the emergency room, waiting for someone who does not have Covid-19 to open the bed. He was transferred to one just before dawn. Dr. Andrew Sanchez, an intern assigned to care for the patient, woke him up the next morning to introduce himself and try to figure out how to proceed. The blood test sent by Kandalaft for muscle injury was helpful. This is 40 times more than it should have been, which indicates serious damage.

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