kaigou: It's dangerous to go alone, Alphonse says, and holds out a cat: here, take this. (2 dangerous to go alone)
[personal profile] kaigou
I know there's some of you out there, so if you have any ideas:

I've got a character who was poisoned. Think a milder, survivable form of strychnine (I think that's the one I mean), where the poison freezes the muscles up. He got a small dose, but it was still close, and as a result his heart's going to take awhile to recover from getting stomped like that. The analogue I've been using is open heart surgery, which apparently does a fair bit of heart-stomping. So I've had the character gradually work his way back to some form of moving about, following the advice given post-surgery to heart patients: walk a bit, then rest, walk a bit more, rest, work your way up to walking up a flight of stairs, lots of rest, etc.

However, the story takes place in the equivalent of the 16th century, so well before any of our fancy modern medicines. Doesn't mean there's no medicine, just that the reasoning might be off (even if the end results work), like thinking aspirin works because of humours, or whatever.

Anyway, so I've got a bit where the character has exerted himself too much, and from what I could tell of the warnings to post-surgery patients, this is why patients often take blood-thinning medicine, to make it easier on the heart. Extrapolating from that, seems like the heart would tire out, can't pump but the body's demanding it, and suddenly you have lack of enough blood, ergo, passing out.

Here's where it might get tricky: the medical person's logic is that a drunk person bleeds twice as much as a sober person from the same-sized wound, so alcohol must make blood run faster and/or be thinner. If blood is normally thick, and the heart is weak, then thinner blood would be easier for the heart. Thus, alcohol is the make-do medicine for someone coming to after dizzy spell, whose heart continues to beat too fast.

In discussions with one of my beta-folks, the point was made that alcohol also raises blood pressure. I know it's a sedative (calm down the heart?), and I thought I found something that mentioned it's also a kind of blood-thinner, so would those positives outweigh the blood-pressure increase? Or would the addition of two shots' worth of alcohol make no substantive difference, or would it actually just kill the character outright?

Anyone? even wild guesses, if there aren't any doctors in the house. tia!

Wild guess here

Date: 12 Feb 2013 04:25 am (UTC)
kathmandu: Close-up of pussywillow catkins. (Default)
From: [personal profile] kathmandu
Alcohol is nervous system depressant. It slows down reflexes in general, could slow down the heart if the heart was being overstimulated *by the nervous system*, but I don't see drinking alcohol making anyone LESS dizzy unless it were by raising blood pressure from a shock-type low-blood-pressure condition.

I'm not sure what your goal is here. Are you determined to include alcohol as a treatment, and looking for ways to justify persons of that time believing it would work? Determined to include alcohol as a treatment, and looking for grounds to declare that it does so work in this storyverse? Or are you looking for any treatments that might actually work in real life, so you can choose one and put it in the story?
Edited Date: 12 Feb 2013 04:31 am (UTC)

Date: 12 Feb 2013 05:31 am (UTC)
surskitty: Yohn (a goat) from Suikoden Tactics with a brush doing calligraphy poorly as she probably doesn't have hands. (HOW DOES ONE WRITE WITHOUT HANDS)
From: [personal profile] surskitty
Is willow-bark tea or some other source of aspirin a workable possibility? :|a

Date: 12 Feb 2013 05:39 am (UTC)
surskitty: Cecile from Suikoden III looking excited while holding Koroku (a dog) (Default)
From: [personal profile] surskitty
Well, it interferes with clotting, and that's either the main or a major idea of blood thinners in general. I know you don't take aspirin or NSAIDs in general if you're already on some sort of blood thinner unless ulcers sound like a good idea to you, but Naka isn't, so.

Date: 12 Feb 2013 10:25 am (UTC)
cyphomandra: vale from brotown thinking (hmm)
From: [personal profile] cyphomandra
Hmm. I think there are two issues here – your analogy for poisoning, which can easily be tweaked, and then your search for treatment, where it does depend what you want from the scene.

First up – strychnine (which I’m going to use as your comparison) basically binds to the nerves that control the motor system (everything you can move voluntarily) and causes them to remain activated. This results in spasms, convulsions, and vomiting, but the main thing that kills people is asphyxiation, due to the muscles that help breathing going into spasm. Toxins from damaged muscles can also poison the kidneys, and if you have a weak heart it may give out under the stress (not directly – heart muscle is not under voluntary control), but basically if you’re otherwise healthy, once you’re over the acute poisoning there should not be any long term outcomes – the blocked receptors the strychnine binds to are removed and replaced automatically, and the strychnine passes out of your system. There’s a case on the net here - http://ccforum.com/content/6/5/456 - and he seems to have been back to normal physically five days later.

Open-heart surgery, by contrast, is usually not done in otherwise healthy people, and involves directly injuring the heart, so recovery is going to take longer for all sorts of reasons. There are poisons that do damage the heart, but there’s a bit of a balance between picking something that causes heart damage and having something your character can ultimately recover from (I’m presuming you don’t want long term complications?). Inflammation of the heart (myocarditis) can make it unstable, prone to abnormal rhythms especially under stress, so a character would run the risk of potentially fatal complications or further damage if they exercised before the inflammation settled, but it needs a different mechanism from strychnine – something that inflames muscle will cause pain and weakness, not spasm.

The thick/thin blood thing and its role in patients with heart problems is one of those areas where better terminology is needed. Blood is, basically, a mixture of cells and liquid. If the proportion of cells – usually red blood cells – goes up, the blood gets thicker, the heart has to work harder, and it’s more prone to clotting. This is what happens in athletes who blood dope, which is why they occasionally have heart attacks or strokes and fall off their bikes.

But blood can also clot for other reasons. Damage to blood vessels (clotting is a defense mechanism), abnormal flow (stasis) or increases in the parts of blood that favour clotting (cells like platelets and various proteins) all cause clots. Treatment for any of these causes tends to involve identifying and treating the cause, but also giving drugs called anticoagulants, which block proteins involved in blood clotting and will help prevent clots regardless of the cause. These drugs are often called blood thinners, but they don’t actually thin the blood in terms of reducing the proportion of cells to liquid, and they won’t reduce the work the heart has to do. People who have too many blood cells usually take anticoagulants, but they also get bled regularly or take drugs to stop them making so many cells.

Patients who have had open heart surgery are prone to clotting because of damage to blood vessels, the healing process after surgery, and the fact that they’re usually lying very still. If they have had certain types of heart surgery (like putting in a replacement heart valve) they are also at more risk of clots. They are on blood thinners for this, not to decrease the work of the heart.

This is a very long answer to say that a) I don’t think your character’s heart would be that stressed unless there’s another mechanism of damage or they have an underlying problem and b) “blood thinners” are not really what you’re looking for. Having said all that, alcohol is a weak anticoagulant. Depending on your level of technology, digitalis (from fox glove) is probably the best historical treatment for a weak heart, and an anti-inflammatory (I think someone else has mentioned aspirin) for myocarditis. Um. I am happy to answer further questions if you have them!

Date: 13 Feb 2013 08:04 am (UTC)
cyphomandra: boats in Auckland Harbour. Blue, blocky, cheerful (boats)
From: [personal profile] cyphomandra
Heart muscle doesn't really work like that - it's different from skeletal muscle (for a start, it contracts and expands an average of 60x per minute), and the only way you can crush it is by tightening the membrane bag around it. If the whole thing is clenched shut, you'll get sudden death rather than long term damage. I also think you're still thinking of muscle injury as a single thing, but there are different sorts of muscle injury and a lot of them heal very quickly. A shoulder injury might take weeks to heal because the whole belly of the muscle has been torn, but if you go running you'll give yourself microtears throughout your calf muscles that will heal within a few days at most.

From a writing plausibility point of view, tho', I would actually be tempted to split the effects you want into poison/antidote. So, your poison either locks up people's throats or paralyses them so they can't breathe, and the antidote/treatment is with a cardiac stimulant to keep things going and just boost them through the whole thing, but the stimulant itself stresses the heart so much that anyone getting it has to take it easy afterwards. (possible natural stimulants - well, digitalis and strychnine). For me this would get around the different mechanisms and time courses involved, and also I quite like the narrative kick of having the treatment complicate the disease. However, if you want a poison that locks up the muscles acutely and then kills them off slowly in the longterm, you could certainly write it, but I'd keep things vague.

Ethanol alcohol is a natural antidote for antifreeze (ethylene glycol) poisoning, actually, but the symptoms don't really fit. If you want something else that would work today (regardless of how it's justified then), I'd be thrilled to see charcoal used as an antidote - crushed up and mixed with liquid to swallow, for example - as this is pretty much the current standard antidote for most poisons. This stops any more poison from being absorbed, but it won't deal with what's already in the system.

Date: 13 Feb 2013 08:24 pm (UTC)
cyphomandra: boats in Auckland Harbour. Blue, blocky, cheerful (boats)
From: [personal profile] cyphomandra
Powdered charcoal will still work - not as well, because the activation process gives the charcoal lots more little pores to soak everything up, but well enough (I can't find a good reference, but a more dodgy one suggests about 4-fold difference in effectiveness). It's certainly been used historically, and I'd buy it as a reader. The more ground up it is the better - the aim is to increase the available surface area.

What Cyphomandra said

Date: 13 Feb 2013 11:19 pm (UTC)
kathmandu: Close-up of pussywillow catkins. (Default)
From: [personal profile] kathmandu
Activated is best, powdered still helps, charred toast also helps.

In fact, the standard broad-spectrum poison remedy is burned toast plus black tea plus milk of magnesia. Burning toast til black (and then soften in milk/water/whatever) is another way to generate free carbon bits, to approximate activated charcoal from a guaranteed-edible source.

[The black tea is to provide an acid; the magnesium is a base. Overall the idea is to neutralize and block from absorption the bad thing you ate.]

Date: 14 Feb 2013 09:58 am (UTC)
cyphomandra: fractured brooding landscape (Default)
From: [personal profile] cyphomandra
Whump away! The problem from a medical pov is combining a) acute poisoning in life/death situation with b) prolonged recovery without c) prolonged decline due to lack of medical treatment. For example, c) makes it difficult to knock off the kidneys, as they don't really cause symptoms until it's too late to do anything pre-dialysis/transplant era. Scarred lungs also won't heal with time - you just slowly get more short of breath, so not ideal.

Think about mechanisms of injury rather than site - infection/inflammation are the main things in this context that will take time to get over but will (usually) get better, like your bronchitis & pneumonia. Something that causes widespread inflammation as a poison is going to have different symptoms from your muscle spasmodic, tho' - more fevers, dizziness, flu-like symptoms, pain, weakness etc.

(sorry for delay! I think we are in completely incompatible timezones)

Date: 15 Feb 2013 02:28 am (UTC)
kathmandu: Close-up of pussywillow catkins. (Default)
From: [personal profile] kathmandu
Acute allergic reactions to food certainly have a reputation for swelling the throat to the point where breathing stops. I just don't know how you'd keep that from being fatal, pre-epi-pens.

Date: 17 Feb 2013 07:26 am (UTC)
erika: (Default)
From: [personal profile] erika
Sorry to show up 3 days later, but does it have to be a poison? I can think of a disease that'll do that.

Date: 17 Feb 2013 08:00 am (UTC)
erika: (games: why i'm hot)
From: [personal profile] erika
Nah, probably not. I doubt it would help him, but it won't /hurt/ him. It also depends on the 'dose'-- are you saying he's going to be given 5 shots worth of alcohol, or is the 'doctor' giving him 2?

If you go with the 'illness during recovery' bit, may I recommend whooping cough? After the initial infection stage, person feels completely fine except for major coughing spasms every 10-15 minutes. It's supposed to work its way out of your body in 3 weeks even without antibiotics, BUT I can tell you for a fact that once it gets established in someone with a crap immune system, you're looking at a 3-6 month recovery period. AND, I can also tell you for a fact that there's no long term damage -- my lungs have the same/better capacity as they did before I had it. :)

Date: 12 Feb 2013 03:54 pm (UTC)
metanewsmods: Abed wearing goggles (Default)
From: [personal profile] metanewsmods

Can I link this from [community profile] metanews?