Dr. Joseph McGinley credits luck and his background in mechanical engineering for fostering the idea of Botox treatments for exertional compartment syndrome.
It was 2011 and McGinley was practicing out of Casper (Wyo.) Medical Imaging, where he is still based. He was contacted by the parents of Laura Stamp, who excelled in soccer, cross country and Nordic skiing for Natrona County High School.
Here's how McGinley described the birth of his revolutionary procedure in a recent telephone interview:
"I didn't know much about compartment syndrome. We had a young girl in Casper, an excellent high school athlete, a multi-sport state champ, diagnosed with compartment syndrome. Her parents had sought every type of alternative treatment to prevent the (fasciotomy) surgery because they knew the risk and they knew the consequences. But they finally threw in the towel and conceded they were going to go have surgery.
"I happened to be giving a lecture in town on vascular compression and I was talking about artery entrapment. One of my colleagues said, 'My daughter is playing soccer with a really good athlete who has similar symptoms to that and I don't think they included that in their workup.' I said, 'Send her in, I'll work it up and make sure it's not artery entrapment.'
"She came in and we did the imaging study and by chance the technologist scanned a little bit higher in the leg than we typically would. What I noticed was that she was compressing her veins and not her artery. I thought that looked a little bit funny and atypical. I thought about it a little bit. From a fluid mechanics standpoint it made sense because blood flow was getting into the calf, but as the veins were being compressed, blood flow is not getting out. That could cause symptoms similar to compartment syndrome. That had never been proven or discussed or mentioned before.
"I did a quick procedure using Lidocaine to stop the function of the muscle that was compressing the vein. We retested that patient and she got better immediately. We could not make her symptomatic no matter how hard we tried. But the Lidocaine wore off.
"It took me a little while to figure out 'How do I stop a muscle from compressing a vessel yet still let an athlete play?' Botox came to me as an option. Once I had that idea I called the parents. I talked to the mom and said, 'Don't hang up on me, I have a great idea on what we can do to treat this. I'm not crazy.'
"They happened to be scientifically based engineers and things like that, and they loved the idea. Botox is a relatively safe drug. Worse-case scenario it doesn't work. There's really no harm in doing it. So we tried it. Two weeks later once the Botox kicked in, she got better. She completed her entire season of soccer, ran a half-marathon, stuff she could have never done before. It was a great story from the start. Some of it was luck and some of it was applying mechanics to solve the problem instead of just a flow chart of symptoms."