Medical Strangulation

Gunja, a 31 years old pretty vivacious woman who works as a medical administrator in a corporate hospital and stays alone in an apartment, is perpetually frightened ever since she survived a near death experience from suffocation a year ago.

Over the last two years, every now and then she suddenly breaks out into angry itchy hives all over her body, along with a feeling of choking that makes her gasp for breath.

She recounts in horror when she had a particularly bad attack one early morning while she was alone at home. Soon after the skin hives started appearing, she experienced a feeling as though someone was tightening a noose around her throat. She gradually turned blue and lost consciousness.

Luckily, she had been able to pick up her cellphone and make a call to her doctor-friend who, sensing something seriously wrong had rushed to her home and injected her with adrenaline, which had saved her in the nick of time.

Subsequent tests showed that she suffered from a rare condition called angio-edema, in which an individual is prone to develop swelling (or edema) of the soft tissues and mucous membranes of the body on provocation by certain foods, medicines, bee stings, wasp bites or minor trauma. When the swelling occurs in the neck, especially around the wind-pipe, it obstructs the air passages, sometimes causing death from suffocation.

Angio-edema is rare, but many probably die due to lack of recognition and timely action. Gunja has been fortunate in that she works in a hospital, and her caring medical colleagues have been able to put

her through the requisite tests and prove that she indeed has a deficiency of a C1 q esterase enzyme that is the hallmark of this condition.

Medical suffocation, be it from angio-edema, or anaphylaxis a severe form of allergy, requires prompt recognition and action. Though intravenous injections of anti-allergics and corticosteroids often work, the specific therapy to turn things around is a subcutaneous injection of adrenaline.

A special pre-loaded adrenaline pen, or epipen as it is called, looks quite like an insulin pen, and is easy to self-use. It is helped save many lives. One just needs to jab it on one’s thigh and inject it.

That delay can cost lives was realised when a 14 year old Irish girl, Emma Sloan died of peanut allergy in a restaurant a few years ago. Seeing her daughter get breathless in a restaurant, her mother had rushed to the nearby chemist’s shop to procure an epipen. The Irish chemist refused to dispense the injection without a valid medical prescription. The young girl had collapsed and died minutes later.

Saving lives is sometimes all about timing and promptness. In the words of JFK, “The difference between salad and garbage is in the timing”.

My naughty mind often wonders what would be the fate of such patients if our courts were to decide on their treatment?