Flights of Fancy and Sausage Poisoning

Started in pain today. That ride yesterday that was supposed to loosen up my legs made them almost immobile. Ahhh, exercise feels great. The past three years of being kept like veal in medical school have definitely caught up to me. Atleast I am tender and tasty.

This is one of those medical-talkin' posts. Arriving at work this morning (after doing my Air Attack routine - note that the ads at the top of the page have scanned my writings and changed from Nome advertisements to jump shoe ads) I picked up the favorite patient of all general practioners, the woman and her child who each came in three times in the past four days. Both, excrutiatingly healthy. Both with no new diagnosis today. A Cox-2 inhibitor and a scheduled barium swallow to fule out the remainder of any illness that may have befallen either one of them. It took me nearly two hours to get everything arranged and squared away. As I finished my paperwork, a call came over the radio that there was a four wheeler accident in Elim, a small village to the east accessible only by plane down the coast. Head injury, seizures, and bleeding out of multiple orafices. This happens a lot around here, but it is still an emergency, and a plane was dispatched almost immediately. Within about 5 minutes, another call came in from Teller, a village to the west of us, about a through and through gunshot wound to the chest, lack of breath sounds on the left, palpable blood pressure of 70 and respirations of 30. Not a good picture. We only have two flight medics currently so they had to split the cases, and another plane had to be found. They also needed a couple of extra medical personel, and "warm body at the right time" got to go to Teller. We had to wait a few minutes for another plane to come in , but a twin engine Navajo was outfitted for medicvac and we were off. Not to diminish the plight of the injured (she is okay) but the flight was beautiful. Flying up the coast, over the second highest peak on the Seward Peninsula (3800 ft), and landing on the dirt airstrip of this small town was spectacular. We arrived and the patient was in the community health center, fortunately much more responsive and in much less danger than we had been led to believe by the radio transmission. We made certain she was stabilized and flew her back to Nome, for evaluation and refueling if she had to be taken to Anchorage. The happy ending was that the bullet, entering in her left chest, missed lung, heart, major vessels, major nerves, and any bony structures, exiting between her scapula and head of the humorus all in soft tissue. A very fortunate young woman, and an exciting day out of clinic. I hope to experience a couple more medivac trips before my time is up.

Now, I promised you sausage poisoning. So, botulism is a big thing up here. Why? You may ask. Well let me tell you, with a little history thrown in. Botulism, or sausage poisoning as it was originally termed, was first seriously studied following an outbreak in Wildbad, Germany in 1793. The outbreak involved 13 people of whom 6 died, and was associated with locally produced blood sausage. Shortly thereafter, the illness became know as "botulism" after "botulus" the latin word for sausage. I won't go into all the toxin details, but the clinical signs are nausea, diarrhea, vomitting, abdominal pain, ileus, urinary retention, dry mouth, blurry vision, diplopia, unreactive pupils, muscle paralysis, fatigue, and dyspnea. For those non-medical types, basically a lot of intestinal and respiratory disturbances and paralysis. Bad news.

So why is it so prevalent up in Northern Alaska? All cases in Alaska (over 200 over the past 50 years, way more than the Lower 48 states combined) have been in association with the preparation and storage of traditional Alaska Native foods. This includes "fermented" foods (lutefisk anyone?) and foods prepared in seal oil. Whale and seal are the most frequently involved foods. As described by Nelson, an ethnographer is 1971, "Meat is frequently kept for a considerable length of time until it becomes semiputrid. At Point Barrow, in the middle of August 1881, the people still had the carcasses of deer which had been killed the previous winter and spring. the meat was kept in small underground pits, which the frozen subsoil rendered cold, but not cold enough to prevent the bluish fungus growth which completely covered the carcasses of the animals and the walls of the storerooms."

There are foods such as "stink eggs" and "stink heads" which are fermented salmon eggs and heads, respectively, which are prepared by placing in underground pits, or inplastic lined barrels above ground. There are decayed until even the bones have become the same general consistency as the flesh, and then kneaded into a pasty compound and eaten as a favorite dish by some people.. Salmon eggs are also left to dry out in a manner which they found a "cheese" which is firm on the outside and soft in the center. There have been increasing numbers of cases due to people speeding up the fermentation process in glass jars or plastic bags, and higher than normal temperatures. This has allowed the toxins produced by C. botulinum to replicate at a maximum efficiency.

There. Lesson learned. If you could see the picture of putrified whale flesh that I am looking at, you would be even more grossed out by this section. I hope you have learned something, and thanks to "Botulism in Alaska" a pamplet produced by the State of Alaska, from which I stole most of the last couple of paragraphs directly.

Today's latin: botulus = sausage

Enjoy