Dr James Le Fanu: 11 April
There are eight instances in the bible of that most impressive of miracles, the restoration of life to the recently dead. Nowadays, this is known as the delayed Lazarus phenomenon (for obvious reasons) when – in technical science speak – the restoration of spontaneous circulation (ROSC) is observed after the cessation of cardiopulmonary resuscitation (CPR).
The usual scenario is that the patient is admitted to hospital with a heart attack but fails to respond to protracted attempts at resuscitation. The curtain is drawn and the body covered, until an observant nurse notices disconcerting signs of breathing and movement ‘under the sheet’.
Dr Radha Sundaram of Glasgow’s Western In rmary, writing in the Journal Of The Royal Society Of Medicine, describes 38 cases of the Lazarus phenomenon, where the onset of ROSC following the cessation of CPR ranged from ve minutes to more than half an hour. The presumed mechanism involves the over-in ation of the lungs with air during resuscitation, constricting the movement of the heart. This then resumes its normal rhythm ‘after death’ as the air disperses out through the mouth and nostrils.
The Lazarus phenomenon can also be stretched to include such scienti cally inexplicable cases as the Polish railway man Jan Grzebski, who allegedly ‘woke up’ after 19 years in a coma to discover his world had utterly changed – not just communism overthrown and democracy restored but that he had 11 grandchildren.
The great Catholic sage Cardinal John Henry Newman acknowledged the di culty in de fining the truly miraculous. ‘It will happen that many occurrences called miraculous, strictly speaking are not such,’ he wrote, ‘but rather providential mercies.’ Still, he insisted that given the Deity’s allpowerful and omniscient attributes, then miracles must be ‘positively likely’.
This would seem to include the process currently of great interest to scientists who claim to have found con firmatory evidence of the Big Bang when, 15 billion years ago, ‘in a moment of glory too swift and expansive for any form of words, a speck of matter became in a million millionth of a second at least 10 million million million times bigger’ and our universe came into being.
This week’s medical query comes courtesy of a lady from Sussex who, several years ago, had half her thyroid gland removed after it was found that one of the minuscule parathyroid glands – that control the level of calcium in the blood – was found to be malignant.
She has had no further problems with her remaining parathyroid glands but is increasingly troubled by a rapid heart beat, tremors in her hands and upper torso and severe tiredness. Her family doctor and hospital specialist have tested her thyroid function on several occasions but the results have come back as ‘more or less normal’. What, she wonders, could be going on?
These symptoms are certainly strongly suggestive of an overactive thyroid though this is unlikely to be related to the operation on the parathyroid gland. The crucial question here is what is meant by ‘more or less normal’, as the nding of a ‘low normal’ thyroid stimulating hormone is still compatible with an overactive thyroid.
PERFECT SHOT
The time-honoured reaction to someone choking of thumping the victim vigorously on the back may disimpact the obstruction by stimulating a coughing t. But recently, a reader from Anglesey has drawn attention to the value of the rather di erent manoeuvre of raising the arms above the head.
‘More than 50 years ago, my mother started choking when we were eating dinner and my father tried in vain to help by slapping her back. She was becoming more desperate and we children were more frightened. I was 12 and suddenly recalled a snippet of information I had read somewhere.
‘“Shoot your right arm up,” I shouted at her. She complied and the pea causing the obstruction shot out of her mouth and sailed across the room, hitting the dining-room door 10 feet away. The family burst into laughter with amazed relief.’
Email drjames@lady.co.uk
The usual scenario is that the patient is admitted to hospital with a heart attack but fails to respond to protracted attempts at resuscitation. The curtain is drawn and the body covered, until an observant nurse notices disconcerting signs of breathing and movement ‘under the sheet’.
Dr Radha Sundaram of Glasgow’s Western In rmary, writing in the Journal Of The Royal Society Of Medicine, describes 38 cases of the Lazarus phenomenon, where the onset of ROSC following the cessation of CPR ranged from ve minutes to more than half an hour. The presumed mechanism involves the over-in ation of the lungs with air during resuscitation, constricting the movement of the heart. This then resumes its normal rhythm ‘after death’ as the air disperses out through the mouth and nostrils.
The Lazarus phenomenon can also be stretched to include such scienti cally inexplicable cases as the Polish railway man Jan Grzebski, who allegedly ‘woke up’ after 19 years in a coma to discover his world had utterly changed – not just communism overthrown and democracy restored but that he had 11 grandchildren.
The great Catholic sage Cardinal John Henry Newman acknowledged the di culty in de fining the truly miraculous. ‘It will happen that many occurrences called miraculous, strictly speaking are not such,’ he wrote, ‘but rather providential mercies.’ Still, he insisted that given the Deity’s allpowerful and omniscient attributes, then miracles must be ‘positively likely’.
This would seem to include the process currently of great interest to scientists who claim to have found con firmatory evidence of the Big Bang when, 15 billion years ago, ‘in a moment of glory too swift and expansive for any form of words, a speck of matter became in a million millionth of a second at least 10 million million million times bigger’ and our universe came into being.
This week’s medical query comes courtesy of a lady from Sussex who, several years ago, had half her thyroid gland removed after it was found that one of the minuscule parathyroid glands – that control the level of calcium in the blood – was found to be malignant.
She has had no further problems with her remaining parathyroid glands but is increasingly troubled by a rapid heart beat, tremors in her hands and upper torso and severe tiredness. Her family doctor and hospital specialist have tested her thyroid function on several occasions but the results have come back as ‘more or less normal’. What, she wonders, could be going on?
These symptoms are certainly strongly suggestive of an overactive thyroid though this is unlikely to be related to the operation on the parathyroid gland. The crucial question here is what is meant by ‘more or less normal’, as the nding of a ‘low normal’ thyroid stimulating hormone is still compatible with an overactive thyroid.
PERFECT SHOT
The time-honoured reaction to someone choking of thumping the victim vigorously on the back may disimpact the obstruction by stimulating a coughing t. But recently, a reader from Anglesey has drawn attention to the value of the rather di erent manoeuvre of raising the arms above the head.
‘More than 50 years ago, my mother started choking when we were eating dinner and my father tried in vain to help by slapping her back. She was becoming more desperate and we children were more frightened. I was 12 and suddenly recalled a snippet of information I had read somewhere.
‘“Shoot your right arm up,” I shouted at her. She complied and the pea causing the obstruction shot out of her mouth and sailed across the room, hitting the dining-room door 10 feet away. The family burst into laughter with amazed relief.’
Email drjames@lady.co.uk