Evil League of Evil Writers: ask Dr. Dina

Showing posts with label ask Dr. Dina. Show all posts

Monday, February 3, 2014

Series Post: Ask Dr. Dina - Sutures

I talked last summer about cuts and punctures. Today I want to talk about sutures.

What are sutures, you might ask? Well, that's the fancy medical speak for "stitches." (Staples are different. Those are a different material used to close a wound, while stitches is the name of the actual process involving sutures. It's complicated.)

Now, you generally only need a wound closed ("need stitches") when that wound is over ¼ inch deep (you can sometimes see fat or bone in these cuts), somewhere on the body that moves a lot or is very elastic (like the face or hands), or is really long (about an inch or longer). Here's a great resource for questions (pay no attention to the hippy behind the curtain).There are always exceptions, though, so if you've got a wound that bleeds for over ten minutes despite holding direct pressure over it or is in a place where the edges won't stay closed with a bandage, go to the emergency room/get help. Always play it safe. It's better to get something looked at than ignore it.

Now, having said that, let's talk about what drives me nuts.

It drives me absolutely batshit when I see someone in a movie/TV show/story getting stitches and then the person doing the suturing cuts the suture with their teeth.

First of all – NO.

NO. NO. NO. NO. NO.

FUCKING HELL NO.

Am I making myself clear, here?

Now, unless said character is using an actual sewing needle and cotton thread (like in the Thomas Jane version of The Punisher) to sew someone up, breaking suturing material with your teeth is stupid for several reasons –

1) suture kits come in sterile packs with SCISSORS RIGHT IN THEM. See? http://www.wisegeek.com/what-are-suture-kits.htm http://www.simulab.com/product/suturing/suturing-instrument-kit

If there are scissors RIGHT THERE and your character uses their teeth to cut something instead of those, put your fucking pen down and go to your room and think about what you've done. Stop trying to look cool with your faux-badassery (hint: there's nothing badass about chomping on sutures) and write the scene properly.

2) most sutures are made of a polymer material (polyglycolide), which in layman's terms pretty much means FUCKING PLASTIC. Most are braided/more than one strand and are designed to be tough/not break, so you might be chewing on them for a bit. There are some sutures that are a little more flexible (like silk for certain wounds), but for the most part, you're getting fucking plastic cord, okay? It's not just going to snap because you bite it once.

3) HELLO HIGHLY UNHYGENIC. You just cleaned the wound. You're spending all this time closing it up, and now you're going to put your nasty-ass mouth RIGHT NEAR AN OPEN WOUND YOU JUST CLEANED AND GET YOUR SLOBBER ALL OVER THE NICE STERILE SUTURES YOU JUST PUT IN? Are you fucking KIDDING ME? (Again, if you're using actual sewing needle and cotton/whatever sewing thread, you're really not caring much about sanitation here, so I'll technically give you a pass, but SERIOUSLY? COME ON!) The human mouth is one of the filthiest places imaginable. Don't put sutures in your mouth! No, not even the end bit!

These are just a few reasons why you shouldn't have your characters do this. I could go on, but you get the idea. DO NOT DO THIS. If I catch you doing this stupid shit in your writing, you and I are going to have words, then I will give you something that will result in you getting to experience firsthand how sutures are properly done.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Monday, November 18, 2013

Series Post: Ask Dr. Dina - Eyestrain Reloaded

Monday, November 4, 2013

Series Post: Ask Dr. Dina - Choking, Strangling, and Other Fun

used with permission wikipedia creative commons

Throat Anatomy (used with permission via Wikipedia Commons)

This is why you'll see health care professionals making a cut on the throat in medical dramas to get a tube in to help someone breathe, because the airway is compromised in some fashion and they need a tracheotomy.

Choking is when air can't get through the trachea (aka "windpipe") because something is preventing it (like someone's hands around a throat, a piece of food, water down the airway, etc.) from reaching the lungs.

Asphyxiation is the lack of oxygen. This can be from gases like carbon monoxide, smoke, chemical agents, sleep apnea, a drug overdose, exposure to toxins, smothering (like a pillow over the face), low atmospheric pressure like high altitudes or a vacuum like space, disease, crushing of the chest not allowing expansion of the lungs…lots and lots of things can cause asphyxiation. You've all heard of auto-erotic asphyxiation? Yeah. This means intentionally decreasing the supply of oxygen (usually via constricting the airway by a choking or hanging method) in order to experience a heightened sense of euphoria during orgasm. (NOTE: DO NOT TRY THIS AT HOME. THIS IS HOW PEOPLE DIE, BECAUSE THERE IS VERY LITTLE VOLUNTARY CONTROL OVER THE BODY DURING ORGASM AND IF YOU ARE CHOKING OR HANGING YOURSELF YOU CAN AND PROBABLY WILL PASS OUT COMPLETELY AND DIE. THEN SOMEONE FINDS YOUR NAKED, BLOATED CORPSE AND KNOWS WHAT YOU DID THERE AND WE'RE NOT GOING TO TALK ABOUT THAT RIGHT NOW, EITHER, SO MOVE ALONG.)

Now you know the difference between the two, what's the point?

The point is, use the proper term. When your character "has the life choked out of them," explain by what. What's doing it? Are they choking on something (is something in the airway?) or are they being strangled? Or do you mean they're suffocating/asphyxiating in a smoke-filled room because their house is on fire?

Choking is violent. There's usually coughing and flailing and struggling and clawing at the throat and so on, and if you're lucky enough to have someone around who knows the Heimlich maneuver, you might make it out of the situation alive. If you're alone, find a chair or something. You've only got a few seconds, though, because the average person can only go about seven to fourteen before passing out from lack of oxygen. Hint: This is a very, very narrow margin and passes interminably slowly when you're fighting for your life, so if you (or your character) are choking, work fast. Did you ever play the fainting game when you were sleeping over at someone's house? Good. Don't. It's dangerous and some people never wake up.

Strangulation is pretty much the same thing. Strangulation is a physical thing that compromises the air flow, only it's usually outside the body. There's all sorts of differentiation when it comes to strangulation, but they all pretty much have to do with trauma to the throat area. Chokeholds are common in a lot of martial arts/blood sports/combat scenarios, because you're trying to incapacitate your opponent by cutting off their airflow. They can't breathe, they pass out, threat neutralized. They're called chokeholds for this very reason – you're choking them. Remember, the window for this is very small – seven to fourteen seconds – so if your character can do it right, it's a good way to have them deal with a hostile rather than having them attempt to knock the baddie out with a frying pan.

Strangulation also applies to garroting and hanging.

Smothering is when your character walks into a room filled with smoke or other gas and passes out because they can't breathe. Other than having a pillow pushed over someone's face, smothering usually isn't violent. It's quick and quiet - and in the case of some gases, invisible and painless -, which is why the gas chamber was once considered a humane form of capital punishment.

Again, if you're writing these things, know the terms to use.

Technically they're interchangeable and no one will really call you on it, unless you get a nitpicky medical professional like myself who really hates it when a character being strangled is written as "smothered in blood." No, smothering is totally different than strangulation. "Smothered" is asphyxiation, not choking. You could say "drowning in his own blood," because that's saying that blood is obstructing the trachea/entering the lungs (we'll get to what drowning is and does in another post – just go with it here) and causing the character to choke/be strangled by the liquid. Then you'd be medically accurate, which is what you want, right?

RIGHT?

That's what I thought.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Tuesday, October 8, 2013

Series Post: Ask Dr. Dina - Temperature

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

Hello Evil Readers! I have returned!

Welcome back to the Ask Dr. Dina series of posts covering medical issues in your writing.

For those just joining us for this series, so far we've covered:

Loss of Consciousness

Altered Levels of Consciousness

Broken bones

Soft tissue injuries like sprains and strains

Bruises

Cuts and Punctures

Burns

and infection, which was divided into four parts: bacterial, viral, fungal, and treatment.

Now that you're up to speed on all we've done so far, let's go on.

Today I want to talk about body temperature.

Humans are an interesting species. They're homeostatic creatures (remember science class? "Homeostasis" [loosely defined] = keeping things the same [stable] inside despite what's going on outside), which is important when it comes to things like body temperature.

What this means is that, no matter the weather, humans body temps need to stay about the same in order for them to function. Unlike reptiles ("cold-blooded" animals whose body temp is regulated by the environment they're in) , mammals (humans are mammals, in case you've forgotten) and birds (not mammals, in case you've forgotten) need their body temperature to stay at a certain level in order to survive. Too cold (hypothermia) or too hot (hyperthermia) and things go awry. Sometimes they get bad, sometimes they don't.

Let me explain.

Say you have your character trudging valiantly through frozen tundra. They're not properly dressed and their teeth are chattering from the cold and they are wandering around delirious.

Yeah, you might want to look to that. You see, teeth chattering and shivering stops after a certain degree of hypothermia. If your character is cold enough that they're shivering and their teeth are chattering, they're not, in reality, cold enough to be delirious. They're very cold and, while miserable, still in possession of their mental faculties, though they may not be as sharp as when they're not butt-cold. Those mental faculties might only be "fuck it's cold holy fuck oh my god shit shit shit it's freezing out here!" but their brain is still functioning. Delirium usually only occurs as hypothermia gets worse. Your mileage may vary.

Now, how cold are we talking about? Well, here are some numbers for you, directly from Wikipedia:

Normal human body temperature generally runs somewhere between 97.7–99.5 °F (36.5–37.5 °C) [Note – some guidelines increase this to 94–100 °F (34.4–37.8 °C) because again, your mileage may vary]. For example, my own personal temp runs somewhere around 97.6°F (36.4°C), so when I start getting chills/"running a temp" of 99°F (37.2°C), I have a fever. Why? Because my internal body temperature has gone up by two degrees, and that's at the threshold of "low-grade fever."

It's when things outside your normal happen (your homeostasis is disrupted) that stuff starts getting weird. Now, were my internal body temperature affected by those two degrees in the opposite direction, I'd be heading toward hypothermia. Again, I run about 97.6°F (36.4°C), so two degrees would put me at 95.6°F (35.5°C). Now, remember:

Hypothermia – temperature lower than 95.0°F (35.0°C).

Hypothermia is basically fancy medical speak for "the body can't warm itself faster than it's being chilled." (Remember that "homeostasis" thing? Yeah. The "stasis" part is being fucked up.) Warmth takes a lot of internal work, and when things outside get too much for the inside to keep up with (like, say, your wandering charrie out there in the cold) its grip on homeostasis starts to slip. By that reckoning, lowering my normal temperature by just two degrees puts me in the early stages of hypothermia.

What are those signs and symptoms?

(Note: "signs" are things that can be seen by others, while "symptoms" are things that are felt by the person affected.)

Signs of mild hypothermia may include shivering, cold to the touch, teeth chattering and so on. Obvious signs that someone is cold. Symptoms may include things like increased blood pressure, heart rate and respirations (this is the body working harder to warm itself – the heart beats faster and harder to get more blood out to the cold bits, and so on). There might be a bit of confusion mentally as well, but that's getting down into the more moderate version.

Moderate signs include more violent shivering, slurred speech, slow movement, stumbling, obvious coordination issues, clear confusion/disorientation, and pallor, while lips, toes, fingers, and ears take on a bluish tint. People in this stage can get really pissy too ("combative"), because hey…wouldn't you be pissed off if you were cold and everyone was in your face and you didn't know why?

Severe hypothermia (we're talking 82 °F [28 °C]) is when the person can barely speak, move, or think. Any skin exposed to the cold is blue and looks swollen, walking is all but impossible, and if they have any kind of mental ability at all, they do weird shit like try and hide in small spaces and take off their clothes. (The "getting naked" thing is really common in severe hypothermia, and is called "paradoxical undressing." You'd think when you're cold you'd want more clothes on, but for some reason, something short-circuits and your brain confuses cold with hot and you start getting naked, exposing your body MORE to the cold, so…yeah. That's why it's called "paradoxical" – because it makes no damned sense.) The thing about severe hypothermia is that it's tough to get back from. Severe hypothermia is what we call "freezing to death." No, really. I mean it. Your core temp dips below 85 °F (29.4°C), that's a long trip to make back. I know ten degrees doesn't sound like a whole lot, but really…in the grand scheme of things it is for homeostatic creatures.

Temperature regulation is critical for our species. When it's out of whack for whatever reason, it gets bad. Too hot is just as bad as too cold. Too hot in the fancy medical speak is called "hyperthermia." (See how fun that is? "Hypo" = low/less/below/under/beneath/down, "hyper" = high/more/excessive/above/beyond – you get it)

Hyperthermia is when body temperature is above 99.5–100.9 °F (37.5–38.3 °C) [Note: hyperthermia is different than fever, which is called "pyrexia." The difference is the cause of the temperature change. Fever is an internal change in temperature while hyperthermia is outside temps elevating it, like heat stroke.]. Hyperthermia is the exact opposite of hypothermia in that the body absorbs more heat than it can dissipate (instead of more cold than it can deal with).

Ever had heat stroke/heat exhaustion? Congratulations – you've experienced hyperthermia. (Some drugs can do this too, as can certain hormonal/medical conditions, but we're not going to get into that.)

Signs of hyperthermia include redness, flushing, hot dry skin (no sweating), nausea, vomiting, and headaches. Maybe some dizziness and fainting if the affected person gets up or is moved too quickly.

In cases of severe hyperthermia, it might seem like the person is drunk off their ass. They're slow to respond, confused when they do, are aggressive or grouchy, maybe even hostile. Don't worry – it's just the heat affecting their brain. Literally. This is a bad, bad situation. They need to be rehydrated and cooled down before their brain cooks itself to death (and the brain is a sensitive organ). If they fall unconscious, it may be too late.

Now I'm not going to get into treatment for these things now. That's another post in itself and this thing is already really long. Let's talk a little about fever then we'll call it.

Loads of things can cause a fever – a lot of exercise in a hot room, eating certain things, wearing too many clothes (remember that "paradoxical undressing" thing? Yeah.), medications, infection, humidity…and lots, lots more. I could do a post itself on fever, but here's the gist:

Fever by the numbers-

Fever is a body temperature greater than 99.5–100.9 °F (37.5–38.3 °C). We've all had a fever. It's miserable, and while you're hot, you actually feel cold sometimes. This is because your body is trying hard to get rid of whatever it is that's screwing with your normal thermoregulation, be that a virus or bacteria or whatever, and since your temperature fluctuates, the constant change makes you feel hot, then cold, and so on.

A little fever won't hurt you. In most cases, fevers are actually good, because they're working on your side to get things (your thermoregulation) back to normal (homeostasis). It's when fevers get out of hand that they become a problem.

Hyperpyrexia (excessive fever) is when the body temperature is greater than 104–106.7 °F (40.0–41.5 °C). This is getting into the "brain damage" area. Temps this high can cause seizures (usually in children but not exclusively) and even death if they're not dealt with immediately.

So, if you have your character trudging through a hot desert (or even just a hot sunny day in the city, where all that heat is reflected off tall buildings and so on) without any water for hours, they're going to be pretty parched if they're not going to suffer the effects of heat stroke/exhaustion. (Also, side note – you don't want to rehydrate them too quickly or they'll just vomit it back up which just adds to the "liquid loss" issue. Further, your character can't sweat if they haven't had anything to drink to sweat out, so…yeah. Research, people!)

That concludes our discussion on temperature. Well, actually, this does:

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Monday, August 12, 2013

Series Post: Ask Dr. Dina - Infection Part IV: Treatment

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

ADDITIONAL DISCLAIMER – IF YOU ARE SQUEAMISH/EASILY SQUICKED OUT BY GRAPHIC DESCRIPTIONS OF GROSS THINGS, YOU SHOULD NOT READ THIS POST. THIS ONE IS GOING TO GET…EW. YOU HAVE BEEN WARNED.

PROBABLY SHOULDN'T BE EATING ANYTHING, EITHER.

We've been talking about infection for quite awhile now in our "Ask Dr. Dina" series. This piece was broken into a few parts because there are many, many different types of infection and I wasn't about to write a book on the subject.

These parts were –

I – Bacterial
II – Viral
III – Fungal

Now we've come to the final installment of this piece – Part IV: Treatment. In this piece I'm going to talk about…you guessed it…the different ways to treat various infections.

Let's start with something everyone (hopefully!) does – cleaning. Cleaning the things that touch the infection is just as important as cleaning the infected area itself.

Killing microbes (commonly called "germs") on something is called "sterilizing." You're making something free of contaminants – making it sterile. There are lots of ways to sterilize things, but I'll only talk about a couple here. Hospitals and other places like laboratories and tattoo parlors use a machine called an autoclave to sterilize their equipment using high heat and pressure. Ever see a movie where they take a lighter or candle and run the flame over a blade or pointy object before sticking it into someone? Same principle (and it works, but you have to do it more than a few times to get the thing sterile).

You know those little bleach wipes you can get for the kitchen and bathroom? Those are awesome! Bleach kills a hell of a lot of things, and you don't need much to do it, either. A 10% solution of bleach mixed with water is enough to kill the HIV virus, tuberculosis, hepatitis and other bloodborne/bodily fluid pathogens.

(Here's a link for the technical medical types from the CDC. Warning: unless you speak Science, this is going to hurt your brain: http://www.cdc.gov/hicpac/disinfection_sterilization/3_2contaminateddevices.html )

Alcohol is another good thing to use to sterilize something. We've all seen movies where a character is injured and someone pours vodka over the wound and the character screams. Yeah, that's about right. It's going to hurt like a bitch to do that. They also pour some over the knife before they begin cutting into the character. Why? To sterilize it! Booze does work if you've got nothing else (the "better than nothing" principle), but there's a lot of other things in booze that aren't so lovely for sterilizing. And it has to be spirits, not beer or wine. Neither beer nor wine have a high enough alcohol content to do anything but wet the wound, make it smell funny, and possibly infect it with some kind of fermenty thing. Best use the beer and wine to get the character intoxicated so they don't whine when you clean their wound with something else. (Note: sarcasm. Alcohol dehydrates you despite it being liquid and shouldn't be given to wounded people. It looks cool, though.) We'll talk more about wound care in another post.

Do you carry a little bottle of sanitizing hand gel (I do!)? If you do, you should make sure it has an alcohol content of at least 60% in order to be effective at killing microbes on your hands. Now this will burn like fire if you get it in an open wound or your eyes, so try not to do that. If you've got a paper cut you're not aware of, I guarantee you the hand gel will tell you all about it. Nothing beats soap, water, and friction (friction is most important believe it or not) for washing your hands (which you should do often, by the way, especially if you touch your face/hair/nose or have small humans in the house), but in a pinch/if those things aren't accessible, hand sanitizer will do.

But all that's just surface stuff. Inanimate objects (called "fomites" in the fancy medical speak) need to be cleaned in order to keep the potential for infection at a minimum. It won't to any good to wash your infected wound in a dirty sink, now will it?

Now that we've talked about cleaning things (treatment!) outside the body, let's talk about how to treat infections on or inside it. Following the order of the previous posts, let's start with bacterial infections.

These are the most common infections, and as we know the most about them, are the easiest to treat. Bacteria are easier to kill than other microbial life for a lot of reasons I'm not going to get into.

I mentioned in the post on bacterial infection that antibiotics are for killing bacteria, not viruses. Now, not every infection needs antibiotics. When your cat scratches you and you get a little red line that gets puffy and stingy for a couple days, yeah, that's likely infected, but it will most likely go away on its own. Your body's natural infection control – your immune system – has that covered. The bouncers will show up and throw the assholes out and send a repair team in to fix the damage Kitty inflicted. It will take a few days, but they'll sort it out. It's when there's more work than your immune system can handle that it needs some help in the form of antibiotics.

Antibiotics come in all sorts of forms. They come in creams and ointments you spread on/in the wound, liquids you pour into the infected area, pills you swallow, and injectables you either shoot directly into the muscle, under the skin, or into a vein through an intravenous line (IV). It just depends on the type of infection you have and where it's located. Most antibiotics aren't over-the-counter except for some creams and ointments (we've all used a triple-antibiotic ointment for a cut or scrape, I'm sure), so if you feel you need an antibiotic for whatever reason, go see your doctor for a prescription. They'll determine if you actually need one. Overprescribing antibiotics is a problem as the things they're trying to kill with them develop resistance to them, which is why if the doctor determines you have a cold VIRUS instead of a bacterial sinus infection, you're (hopefully/probably/most likely) going to be told to go home, take some acetaminophen, drink lots of fluids, and rest.

Which brings us to viruses. As said both above and in the post about bacterial, antibiotics DON'T WORK ON VIRUSES. What does? Well…not a whole lot. There are some antivirals out there, but they're not designed to kill the virus they're treating. They're designed to make it hard for the virus to grow/develop. Not only that, but antivirals are target-specific. You may have heard the term "broad-spectrum antibiotic." What this means is that that antibiotic will kill a whole host of different types of bacteria. Not so with antivirals. There aren't many, and the ones that are out there are for viral infections like HIV or herpes.

Now, as I said above, there are things that kill viruses outside the body, like bleach and other substances, but that's not really a treatment. There are some vaccines against certain viruses (like polio) that are very effective, and some that aren't (like influenza). Medicine continues to search for vaccines for things, but viruses are hard to beat. Prevention is the best medicine for viral infections, because treatment is a complete bitch.

Fungi are also hard to treat, mostly because the duration is so long AND because the little bastards are hard to completely eradicate. Fungi have the unique ability to propagate themselves in almost any environment with only a single spore. They're hardy and like extremes, and even when you think you have it beat, it JUST. WON'T. DIE.

But! They are easier to treat than viruses. Not as easy as bacteria, but we do have ways to deal with them. If you've ever had a cream or other drug that ended in "–zole," you've likely been given an antifungal (or antiparasitic, which I'll toss in here because that's what I did in the post on fungal infections). There are a whole lot more antifungals out there, and all of them work almost exactly like antibiotics – attacking the fungi itself in order to allow your immune system to get a kill strike. Some work like antivirals, and keep the infection from getting anywhere until your immune system has a chance to raise shields and keep it from getting in. Like antibiotics, antifungals come in all different forms (and are often mistakenly called "antibiotics" by health care professionals and laymen alike) with varying degrees of efficacy. Depending on the severity of the infection, an over-the-counter seven-day yeast infection treatment might not work as well as a stronger one prescribed by a doctor. It's the same medication, really, just in a different formula with a more powerful delivery system.

(NOTE: This isn't to say that you should get more of the OTC treatment and use it doubled, because THIS WILL NOT WORK LIKE A PRESCRIPTION. The prescription version is different from OTC for a reason. While most OTC versions work just fine, if you need a prescription version, OTC isn't going to help you. NEVER DOUBLE UP ON OTC DOSAGES OF ANYTHING. "MORE" IS NEVER "BETTER.")

Now, how does all this apply to your character? Well, I'll leave that to you. I've given you post after post as to how infections happen, and now I've told you how they're treated. If you've got a character with a gunshot wound (GSW in the fancy medical speak) and you have them in the back of a car speeding down the street, infection should be the last thing on your mind. Later on, if you have them in a quiet spot, you can have them assess the damage and what to do about it. Hopefully these posts on infection will help you consider the details, like how they're going to sterilize something in that situation (or even if you're going to have them do it).

This concludes the Infection Sequence of the Ask Dr. Dina series. Next time we'll talk about something less gross. Like drowning.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Monday, July 29, 2013

Series Post: Ask Dr. Dina - Infection Part III: Fungal

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

ADDITIONAL DISCLAIMER – IF YOU ARE SQUEAMISH/EASILY SQUICKED OUT BY GRAPHIC DESCRIPTIONS OF GROSS THINGS, YOU SHOULD NOT READ THIS POST. THIS ONE IS GOING TO GET…EW. YOU HAVE BEEN WARNED.

PROBABLY SHOULDN'T BE EATING ANYTHING, EITHER.

We've come now to the infection portion of our "Ask Dr. Dina" series. This piece is going to be broken into a few parts because there are many, many different types of infection and I'm not going to write a book on the subject.

These parts will be –

I – Bacterial
II – Viral
III – Fungal
IV – Treatment

So far in this portion on infection we've covered bacterial and viral types. There are a lot more of them than I touched on, but the gist was there. I'm going to do the same for this one on fungal infection.

When you hear the word "fungus" or "fungi," what do you think of? Mushrooms, right? Yes, those are types of fungi. ("Fungi" is the plural form of "fungus." I know. That seems backwards as you've been taught that plurals end with "s." That's true for most things, but in case you haven't figured it out by now, medicine/science likes to do things its own way. Why? Because science is a dick, that's why!)

The kind of fungi I'm going to talk about in this post aren't shiitakes or portabellas or chantrelles (shut up, hippies). I'm going to talk about microscopic fungi. While you can (and very likely do) ingest these microscopic fungi, I wouldn't recommend it.

What I'm going to talk about today is mycosis, which is fancy medical speak for "fungal infection." Why is it called "mycosis" when that doesn't sound a damned thing like "fungus?" Because mycology is the branch of biology dedicated to the study of fungi. So there you go. I told you - science is a dick.

Let's start with something everyone's heard of. Athlete's foot. You've all seen the commercials or heard about different medications for athlete's foot. You know it's gross and painful and so on. What you may not know is that athlete's foot is so named because athletes' feet are constantly moist from sweat and shoved in the warm, dark environment of a dirty sock and sporting shoe for hours on end, then they walk around barefoot in shower/locker rooms subjecting their feet to even more warmth and moisture, creating the perfect environment for that particular fungus to proliferate. That fungus is one we all carry (part of the natural flora of the human body) called Tricophyton. Now there's a shit-ton of subtypes of this fungus, but you'll most likely know them by their common names – jock itch and ringworm to name a few. (Hint: there's no actual worm involved in "ringworm." It's named that because the little assholes responsible for it [called "tinea" by health care professionals] make lesions that look like a ring/worm under the skin.)

Remember what I said about science/medicine being a dick? Yeah. Why should we call it "athlete's foot" when we can call it something fancy like "tinea pedis?" Your head itches? Tinea capitis! (Ringworm of the scalp! Or, you know, just dry scalp or a fucking itch [dermatitis!]. Don't freak out.) Look, we like our Latin and Greek in the medical community, okay? Medical terminology is a language unto itself and if you want to be in the field, you've got to learn to speak it. No, I mean it. They teach it anywhere medical stuff is on the curriculum.

But I digress.

Now, the above are what are known as "cutaneous" fungal infections; that is, they affect things on the surface/outside of the body like your skin, hair, and nails. When fungus gets inside you, things get a little more difficult to handle.

Yeast infections. Ladies, you know what I'm talking about, right? If you've never had one, consider yourself blessed. Dudes…before you smirk and get all smug, you're not exempt from yeast infections, either. Yeast can affect your bits and bobs, too. Remember what I said earlier about fungus liking moist, dark, warm places to grow? I'll wait…THERE you go. Yeah. That. Now, yeast (called Candida in the fancy medical speak) is part of the body's natural flora. It's when things get thrown off-balance by whatever (stress, medications, diet, what have you) and the little bastards run wild that you have an infection on your hands.

And don't go thinking yeast infections are confined to your lower half. Uh-uh. Parents. Ever had to deal with thrush in your kid? Adults? Ever had thrush for one reason or another? Congratulations. You've had a yeast infection of your mouth. (Warm, dark, moist, remember? The human mouth is utterly filthy. You don't even WANT to know what lives in there, so brush your teeth [and tongue!] often, kids!) Yeast can also infect your skin and even your blood (called fungemia). HCPs (health care professionals, remember?) call yeast infections (no matter where they might be) "Candidasis." Most often the culprit is Candida albicans, but sometimes other species like to play, too.

When fungal infections get even further into the body, things turn really nasty.

Remember our friend meningitis from the bacterial and viral sections? Guess what? Fungus isn't going to be left out of that party. Fungal meningitis isn't contagious or very common, and generally affects people who have been seriously immuno-compromised, like cancer and AIDS patients. A fungus called Cryptococcus is generally responsible for this kind of meningitis. There are a couple of very nasty subtypes of Cryptococcus (NOT to be confused with Cryptosporidium, which is a whole different type of BAMF I'll talk about in a minute), and both are deadly when they set up housekeeping.

Other fungi get into the lungs (pulmonary system) and wreak havoc. One particular nasty is Aspergillosis. Now, normally aspergillis is fine and dandy when it's outside the body. Breathing the stuff in, however…yeah. Warm, dark, moist…you remember how it works. Most people breathe that crap in every day (as it's just in nature/the air) and are utterly fine. It's the same game – your immune system takes care of it if it's healthy. Your immune system is a BAMF too, and works like a boss when it's on the ball. It's when your immune system is compromised for whatever reason (and there are lots of things that screw with your immune system) that things become a problem.

Those of you allergic to "mold" really mean you have a sensitivity to aspergillis or other airborne fungi. (Hint: the "mold" found on bread you may be sensitive to is a fungi also. You might know it as penicillin.) If your character has an allergy to mold, you can't have them working in a bakery, okay? Because yeast has a lot to do with mold. Baking and brewing yeasts are different from the infectious kind, but they do have a tendency to change/ferment/mold, so keep this in mind if you give your character an allergy to mold.

Mildew is the same. Mildew is a common name for types of mold growth. And mold is what? That's right...fungus - usually Penicillium. (In the plant world, mildew refers to a specific type of fungus called Erysiphales, but that's a whole other thing.)

Now while this post is supposed to be about fungal infections, I'm going to touch briefly on parasitic ones as well, mostly because the two are often confused or combined, mostly because they're related. I just mentioned one above.

Cryptosporidium isn't a fungus. It's a parasite. A protozoa, actually, and it's commonly found in contaminated water. It's ubiquitous and worldwide. I had a nasty bout with it on an archaeological expedition once – it's not pretty. Though generally just unpleasant in people with healthy immune systems, crypto (as it's known) can be lethal to the elderly, infants, and others with suppressed immune systems. If you're going to have your character drink from a water source that could be contaminated, chances are they're going to come down with something. You've heard of "Montezuma's Revenge?" Yeah.

Other parasites responsible for infection are helminths (worms, like tapeworm and roundworm) and ectoparasites (things like mites, ticks, and fleas).

Now I'm only going to touch on these. Parasitism is vast and complex and hugely incestuous when it comes to infection. For example, rats carry a type of flea (as do squirrels and other animals) that carry what's commonly called "plague." This is a vague term for Bubonic plague, AKA "The Black Death," (you know…the thing that wiped out a third of the world's population back in the 1300s) and while the flea (the parasite) is carried by rodentia (what's known in epidemiology as a "vector"), the actual cause of the illness is a bacteria the infected flea carries called Yersinia pestis. Same thing with ticks and Lyme disease. The tick itself is the parasite (or "vector"), but it's the bacteria it carries (Borrelia) that causes the disease.

See what I mean about parasitism being incestuous? It's usually not the parasite itself that causes disease, but the bacteria it carries with it, virus it enables, fungus it promotes, or damage it does while infecting.

Remember what I said about vast and complicated? Yeah. Let's just leave our discussion of parasites as it is, shall we? Just things to keep in mind if you have your character slogging through a field full of chiggers (a type of mite) or a cave full of bats.

This concludes part III of the Infection Sequence of the "Ask Dr. Dina" series. Join us in a couple weeks for the final installment of this sequence, where we'll talk about how the various infections I've talked about are treated.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Monday, July 15, 2013

Series Post: Ask Dr. Dina - Infection Part II: Viral

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

ADDITIONAL DISCLAIMER – IF YOU ARE SQUEAMISH/EASILY SQUICKED OUT BY GRAPHIC DESCRIPTIONS OF GROSS THINGS, YOU SHOULD NOT READ THIS POST. THIS ONE IS GOING TO GET…EW. YOU HAVE BEEN WARNED.

PROBABLY SHOULDN'T BE EATING ANYTHING, EITHER.

We've come now to the infection portion of our "Ask Dr. Dina" series. This piece is going to be broken into a few parts because there are many, many different types of infection and I'm not going to write a book on the subject.

These parts will be –

I – Bacterial
II – Viral
III – Fungal
IV – Treatment

Now last time we covered different types of bacterial infections. There are a lot more of them than I touched on, but the gist was there. I'm going to do the same for this part on viruses. I'm not going to get all technical and differentiate viruses into whether they're RNA or DNA viruses, but I will note here that there are different types of them. Also, I'm just going to cover some of the ones that affect humans, because viruses that mainly affect animals (like parvo) is a whole other arena, and would be another post in itself. Having said that, let's go on.

The flu. HIV. The common cold. There are a LOT of viruses out there. Some are mild. Some are nasty. Some will kill you. Some just make you really uncomfortable. Some are curable. Some you just have to suffer with. Let's talk about a few of these, shall we?

Let's start with a cold. If you aren't aware of it by now, there's a difference between having a cold and having the flu. Many, many people aren't aware there is one and think they should be treated the same (with antibiotics, which is wrong, and we'll discuss this in Part IV – Treatment). I've got news for you – NO.

No, and I'll tell you why.

(Now I'm going to generalize here, but this is for the purposes of torturing your character with your writing and being medically accurate. THE INFORMATION BELOW IS NOT to be used for diagnostic purposes as stated in the disclaimer above.)

Your character is sick in bed with some kind of respiratory thingy and praying for the sweet release of death from their misery. Should you call it "a cold" or "the flu?" Remember it this way – if there is FEVER (over 100F/37.7C) = FLU. No/low fever, it's a COLD. Get it? NOT HOT (no fever) = COLD. Easy mnemonic. There are exceptions, of course, especially in small/young humans, but again, this is in general. Don't believe me? Here. Have a link to people who say the exact same thing.

Now, both colds and flu are caused by viruses, and viruses don't respond to those antibiotics people expect the doctor to prescribe for their sniffles. Fortunately the majority of doctors have gotten it through their thick fucking skulls these days that prescribing antibiotics to every yahoo with a runny nose is a Very Bad Thing and have stopped giving everyone who walks through their door with a cough a prescription for amoxicillin, much to the bitchery of said yahoos. But you know what? MOST YAHOOS AREN'T DOCTORS, or even loosely affiliated with the medical profession and think Google gives them a fucking medical degree. Yes, I realize that when you're sick enough to go to the doctor you want them to Do Something To Make It Better Because That's Their Job And You Are Sick, but the answer is NOT antibiotics when you get a cold or even the flu, despite what you may have read on some forum written by a housewife in Bumblefuck, Assholestate.

Why?

See above. Antibiotics DO NOT WORK on cold and flu viruses. Matter of fact, they don't work on viruses, period, (antivirals sometimes do, depending on which and what for) which is what makes viruses Very Bad Things.

Now, if your cold develops into something bacterial like pneumonia (lung infection) or your sinuses/ears get infected from all that drainage, THEN you can think about antibiotics. NOT BEFORE. Antibiotics are for bacterial infections, but I'm getting ahead of myself. This isn't the Treatment part of this infection portion of our series. (I'm kind of militant when it comes to treatment and patient whinage, which is part of the reason I left the medical profession, but I digress yet again.)

Just please don't send your character to the doctor for a cold and have them fill a prescription for antibiotics. THIS IS STUPID AND WRONG and believe it or not, perpetuates the incorrect belief that this is what you do when you've got a cold. STOP THE INSANITY!

Where were we? Oh yes. Colds vs. flu. Now, most colds are caused by a wily little fucker called a Rhinovirus. (Go ahead and laugh. Rhinovirus is used to being laughed at. That's probably why it's such a bitch.) It's a pretty little thing under the microscope, looking like it's wearing a boutonniere. It has to dress fancy like that so your immune system lets it into the party, where it proceeds to get drunk and make an ass out of itself as it takes over everything and makes you feel like utter shit until it gets shown the door by the BAMFs in your immune system known as, I shit you not, Killer T cells. These guys eat viruses for breakfast, but they're kind of busy doing shit and you may have to cope for a couple days before they can get the party-crasher Rhinovirus out of the living room. Rhinovirus is an opportunistic bastard, though, and he's the ultimate couch-surfing moocher. He keeps coming back year after year, maybe wearing a new suit or sporting a spiffy new haircut, but it's always him. Nothing you can do to get rid of his dumb ass but take some over-the-counter cold meds (and there are some awesome ones out there now) to make you feel better until the Killer Ts have time to get to him. They're busy, remember, doing all kinds of other shit, and it will take them a bit to get to Rhinovirus and all the little friends he brought with him. Rhinovirus is an asshole, so try not to invite him to your party. I'll tell you how to discourage him later in the Treatment part of this portion of our series.

Now, the flu. Again. Nothing you can do about this guy. You've heard of swine flu (this was the big H1N1 strain of 2009, and while it was a type of virus known to be associated with swine, actually wasn't THE swine flu, of which there have only been about fifty human cases), Spanish flu (also the H1N1 subtype, also called the 1918 flu), Russian flu (yet again, H1N1), Hong Kong flu (H2N2), bird flu (H5N1) and others. All are types of a virus called…wait for it…Influenzavirus. Now if you want to get all fancy and scientific, the Influenzavirae are types of Orthomyxoviruses, named, stunningly, A, B, and C.

Influenzavirus A is the one responsible for all the fancy different types of flu you hear about. H1N1, H2N2, H5N1, everything. No matter the subtype, it's a member of the Influenza A family.

Now, I know what you're thinking. "I get my flu shot every year!" Good for you! Dr. Dina thinks flu shots are BULLSHIT for the most part. Why? Because the flu changes every year. It's not like measles or hepatitis or any other virus that has an effective vaccine that prevents it. Every year Those In The Know pull a random number out of their ass and say things like "we're due for this strain and this strain and this strain…gonna be a heavy year for those…let's use those in the vaccine this year!"

Now that might seem belittling to those scientific types who I am sure put a vast amount of work into making flu shots, but seriously. Dr. Dina wants more than just 60% efficacy in her vaccine, thank you. Another issue I have with the flu vaccine is that its peak effectiveness is only two to four weeks, after which its protection drops by 50% over the next six months. I would like a little more than a month to half a year's protection from my vaccine, thanks. Though the protection from that vaccine is in theory supposed to last three years, you're encouraged EVERY FLU SEASON to get a flu shot. Why? Because no two seasons have the same flu shot. Does that seem right to you? The shot changes every year because they're never certain from year to year which strain is going to be the one running around with its clothes off at the party that year.

Now, the flu vaccine does benefit some people a great deal. Kids, seniors, people with HIV/compromised immune systems…lots of people benefit from that 60% efficacy guesswork. I'm not saying you shouldn't get a flu shot. I'm saying I, personally, think they're bullshit for me, and I'm a former HCP (health care professional). I was the type that was encouraged to get one because I had direct contact with the people who needed them most. Now while I've never had a flu shot and never intend to get one, I'm all for vaccination against disease. Militant about it, in fact. Ever heard of "herd immunity?" Yeah. That. THAT IS A GOOD THING. Get your vaccinations, people. Whether or not you want to get a flu vaccine is up to you. It's not for me, personally, as I don't consider the flu to be a disease, let alone one I need vaccinating against. It's not pertussis. My former HCP husband gets them every year.

And yet still gets the flu every year. Huh. Must not be lucky enough to acquire one of the strains he was vaccinated against.

Next!

Let's talk about something other than colds and flu. Let's talk about…HERPES! Yeah! That's a fun one. The technical name for this viral infection is Herpes Simplex. Now, there are two subtypes, creatively called 1 and 2.

Cold sores/fever blisters are herpes lesions on the mouth and lips (sometimes below the nose and other parts of the face, including the eyes) and are caused by Type 1 and generally called Herpes labialis. (Fun fact! If you have a cold sore and perform oral sex on someone, you can give them genital herpes. Don't try this at home, kids! Practice safe sex and don't perform oral if you have a cold sore. Also don't let anyone with a cold sore perform oral sex on you.)

Genital Herpes can be caused by Type 1, but is generally Type 2.

Herpes can also infect the fingers, throat and brain. In fact, there's a thought that HSV-1 is responsible for Alzheimer's disease.

I could go on and on about different types of viral infections. I'm sure you've heard of HIV. This is the abbreviation for Human Immunodeficiency Virus. It's the virus (called a lentivirus, a type of retrovirus that develops slowly) that leads to AIDS (acquired immunodeficiency syndrome).

Ebola. You've heard of that one? It's a filovirus that causes a hemorrhagic fever. There are currently five different types of Ebola, plus a similar hemorrhagic fever disease called Marburg in the same family.

Hepatitis. Viral infection. A, B, C…all are viral.

Polio. Meningitis. The types of viral infections is enough to fill a hundred books. There's even a field of study dedicated to it called Virology. Viruses were a passionate field of study for me back in the late 1990s. (I blame the movie And The Band Played On, the AIDS epidemic in the 1980s and Richard Preston's The Hot Zone for this.)

There are a hundred ways to torture your character with viruses. Have your adventurer traipsing through the jungles of the Africa? Infect him with Ebola or other nasty. (Lassa fever is fun!)

Is your heroine finding herself in the desert southwest? Toss a little Hantavirus in there. (Yes, this is a real thing. It's carried in mouse pee. No, really. I promise.)

Most locales have some happy little virus hanging around. A lot of viruses are named after the places they're discovered or expected to be. Medical types call this "endemic." You don't have to be somewhere exotic for this to happen, either.

Now, you sci-fi writers can have a shitload of fun with this. Firefly did. ALIEN did. There are loads of examples of Really Weird Shit Infecting The Populace, and not just in sci-fi. Have a ball with it. Just remember if you're going to make some fancy new virus up, be sure and base it in science and back it up with your world-building.

This concludes part II of the Infection Sequence of the "Ask Dr. Dina" series. Join us in a couple weeks for part III – Fungal.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Monday, July 1, 2013

Series Post: Ask Dr. Dina - Infection Part I: Bacteria

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

ADDITIONAL DISCLAIMER – IF YOU ARE SQUEAMISH/EASILY SQUICKED OUT BY GRAPHIC DESCRIPTIONS OF GROSS THINGS, YOU SHOULD NOT READ THIS POST. THIS ONE IS GOING TO GET…EW. YOU HAVE BEEN WARNED.

PROBABLY SHOULDN'T BE EATING ANYTHING, EITHER.

Now we have come to the infection portion of our "Ask Dr. Dina" series. This piece is going to be broken into a few parts because there are many, many different types of infection and I'm not going to write a book on the subject.

These parts will be –

I – Bacterial
II – Viral
III – Fungal
IV - Treatment

As it's the most common type of infection, bacteria get the first crack at this subject.

When most people think "infection," they think of a cut that's red and swollen and full of pus, and they would be correct. Any open wound – from a paper cut to a gunshot – is capable of getting infected. Any opening in the skin (I'll leave it to your imagination…there you go….) is capable of acquiring an infection, especially if those openings are dark, moist, and warm. As the human body tends to run anywhere from 96-99 degrees Fahrenheit on average and most of our holes are where the sun don't shine, this makes for an ideal environment for all sorts of bacteria looking to set up housekeeping.

It's commonly thought something needs to be dirty in order to introduce infection. Technically true, but, a brand new nail from the hardware store is just as likely to introduce bacteria to the wound when it pierces your foot as a rusty one that's been left out in the dirt for years. It might not be the same kind of bacteria, but it's still just as likely to cause infection. This is why it's important to have your tetanus shot updated. Tetanus is caused by a bacteria called Clostridium tetani, and that little bastard is not only everywhere, it likes wounds of any kind, especially punctures. Tetanus not only hurts like a motherfucker, it's fatal 40% of the time. I don't know about you, but 40% is too close to 50% for me. More than one-third but less than half. So basically, over one-third but less than half of the people who get tetanus die.

And this is 2013.

I'll leave you to ponder those odds. Then call your doctor and get your damned tetanus shot updated if you haven't had one in the last ten years.

Moving on.

As bacteria goes, Clostridium is a bitch. There's over 100 species of that asshole, some of which I'm sure you've heard of –

- Botulism. (C. botulinum) Some idiots shove botulism in their faces for the paralytic effect. They call it "Botox." It's fucking botulism, people. FOOD POISONING. Botulism is why you don't give honey to a child under a year old. Botulism is bad shit. I don't care if your forehead sags, and I don't care how nice they've dressed it up; unless you've got a legitimate medical reason do to this (and there are a few, believe it or not), don't put food poisoning UNDER YOUR SKIN. Fuck!

- Gas gangrene. (C. perfringens) You've heard of gas gangrene, yeah? That lovely putrefaction/death of tissues, skin-splitting-from-bloating thing that happens to corpses and soldiers in historical romance novels? Well, this is another lovely aspect of Clostridium. (Gas gangrene is not to be confused with "dry" gangrene, which is caused by insufficient blood supply/ischemia and is often found in diabetics, the elderly, and people with circulatory issues such as frostbite victims.)

And more. Loads, loads more of Clostridium types. But like I said, I'm not writing a book here, let alone one on microbiology.

Still, bacterial infections are the ones responsible for those lovely pus-filled wounds your character might sport. Even the little ones like a stye in the eye. Styes are infections of the sebaceous glands of the eyelid. They hurt like a bitch and there's nothing you can do about them except wait for them to go away. Oh, sure, there's some over-the-counter bullshit ointment you can use, but really these are just mineral oil and white petroleum (aka "Vaseline") that make you feel better but don't actually do anything to hurry things up.

Other bacterial infections you may have heard of –

- Acne. Now, we've all had pimples (zits). If you've never had one, congratulations! While not all acne is caused by an infection, there is a bacteria called Propionibacterium acnes that's widely thought responsible for certain types of it. This type of acne is basically a skin infection caused by bacteria. (No, not chocolate, though things like chocolate can exacerbate [this means "make worse"] the oil production in the pores that in turn gets infected by the bacteria that causes the acne.)

- Staph (Staphylococcus). There are some forty strains of staph, and not all of them are bad. We all have staph living on our skin (S. epidermidis). It's part of our natural flora. But when it gets out of hand for one reason or another (disease, immuno-compromised individuals), it gets ugly and a tiny little nick while shaving leads to a Staph infection (including but not limited to cellulitis). Others like MRSA (Methicillin-resistant Staph. aureus) can kill, because they're big, bad, and think your little antibiotics are for pussies. MRSA is most commonly found in hospitals and is a complete bitch to get rid of once it makes itself at home. Keep this in mind if your character ends up in the hospital. Or prison. Prisons are hell for MRSA.

- Strep throat, impetigo, scarlet and rheumatic fever, and toxic shock syndrome are all caused by a bacterium called Streptococcus pyogenes. If you give your character strep throat, well, now you know how they got it.

- Salmonella. There are over 2500 types of this bad boy, but the one most people think of is Enteritis salmonellosis, usually S. enterica, aka "food poisoning." This is the one comes from tainted food, mostly. Raw eggs, improperly handled raw chicken, stuff left out too long (real mayonnaise made with eggs at picnics and so on) – all can be blamed on Salmonella. As can lovely things like typhoid fever. This is a fun one to torment your character with.

- Escherichia coli. Or, more commonly known as E. coli. I'm sure you've all heard of this one. There are some particularly bad strains of this one, but they all come from the same place – shit. No, I mean it. E. coli is found in the intestinal tract of living organisms, and if something was infected with E. coli, that means there's been some kind of fecal contamination, usually via the oral route. Meaning yes, they ate shit. (And since some strains will kill you quick, it kind of gives a whole new meaning to the phrase, "Eat shit and die," doesn't it?) Now, E. coli is a very nice thing to have when it's where it's supposed to be. E. coli helps you with all kinds of things to do with digestion, but when you try and digest it, there's going to be problems. E. coli doesn't like being eaten and is going to fight you on it. This is why it's a very bad idea to shit in your drinking water, yet people do it all the time.

- How about a fun one? Let's talk sex! What? No? Come on! How about a nice dose of Neisseria gonorrhoeae (gonorrhea)? Treponema pallidium (syphilis)? Fine. Chlamydia tractomatis (chlamydia, but you knew that one, right?). Well, okay then. Sexually transmitted bacterium might not be your thing, but that doesn't mean you can't have a party all by yourself with a touch of Candidasis. Wait, that one is a fungal infection. We'll talk about those later, in part three.

- Urinary tract infection. Usually we have Pseudomonas aeruginosa to thank for these. Pseudomonas is also responsible for most burn infections. Remember last time when we talked about burns? Yeah. They get infected too, and Pseudomonas is usually to blame (sorry, Pseudomonas, you bastard). "Blood poisoning" is the colloquially accepted term for "sepsis (or septicemia)" and again…usually (but not always) Pseudomonas. This guy is a real pain in the ass, because it lives everywhere on everything. I SAID EVERYWHERE! EVEN THERE! This boy is badass. But don't hold that against him. I'd be pissed too if my name meant "fake unit."

- Meningitis. Yeah, you've heard of this one. But did you know there are different types? The bacterial one I'll talk about here is the BAMF. This one is the killer. Bacterial meningitis is fast, highly contagious, and deadly. Remember gonorrhea (N. gonnorhoeae)? Yeah. Meet its big brother, Neisseria meningitides. Remember our old friend Strep? He's good friends with N. meningitides. Between N. meningitides and S. pneumoniae, they account for over 80% of the bacterial meningitis cases in adults.

And there are many, many more.

See what I'm saying here? Infection doesn't have to mean a pus-leaking ingrown toenail or a weepy cat scratch or a dirty bandage over a knife wound. It can be an ear infection, food poisoning, or STD.

Now I don't want you going around thinking all microbial life has it in for you. Some bacteria are great. Wonderful even. Necessary for living. Some help you digest food. Some bacteria kill others that would normally kill you (or parts of you). Others make excellent vaccines that keep you from getting infected with other bad things.

Hell, some infections are even beneficial. Infection means just that – something has been infected with something else.

This concludes Part One of the Infection Sequence of the Ask Dr. Dina series. Join us in a couple weeks for Part Two – Viral.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Monday, June 17, 2013

Series Post: Ask Dr. Dina - Burns

ETA - Regular reader and eviltry fan Robert Morris is offering a SHINY in the comments! Be sure you read them and see if you can spot the evil!

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

FIRE!

FIRE FIRE FIRE! Yeah yeah! Huh huh heh heh huh huh….

In case you haven't figured it out by now, this post is going to be about burns.

Now, you don't necessarily need fire to burn yourself, but heat is generally the norm when it comes to searing your character. These are called "thermal" burns in medical speak.

Other ways your character can taste burn-y include chemical, radiation, and electrical. (I know, you'd think electrical burns are thermal burns, and technically you'd be right, but they do a different kind of damage than thermal burns, so get a category of their own. Different types of burns do different types of damage. Lemme 'splain.)

Here. Have a helpful chart. The post below is basically what that chart says, only more with the words and not so medicalish. Onward!

Thermal burns are what people think of most often when they hear "burn." Medical people complicate things (okay, differentiate) by sorting thermal burns by what caused it and what damage was done.

Thermal burns include:

Flash burns - literally just that. Done in a flash. An instant. BOOM. (BADA BOOM!) Explosions of any kind can cause them, such as natural gas, compressed gasses like propane, or other flammable liquids like gasoline and lighter fluid. A lot of heat for a tiny window of time (that will seem like an eternity to the one experiencing it, OR they might not even notice they got burned, it was so fast). SOMETIMES clothing will protect you from flash burns, unless it catches on fire. Then you're going to notice the burning part. Ever singed your hair or eyebrows over a barbecue when you opened it to a giant ball of flame? Congratulations. You've experienced a flash burn.

Flame burns are what most people think of when you say "burn." Flame burns are you on the barbecue. It's fire, plain and simple, and how hot that fire burns depends on what it's got feeding it. Oil burning is a lot more dangerous than wood or paper because it's a liquid and water doesn't do anything but spread it around. You need to smother oil with powder, foam, or anything to wipe it away. House fires, charcoal grills that use lighter fluid, smoking around a can of hairspray, car wrecks, clothes or blankets catching fire from stoves or heaters…there are a LOT of ways to burn yourself the good old-fashioned way.

Scalds are caused by hot liquids. We've all burned our tongues on something hot that we've eaten or taken a sip of. That pot of coffee that just finished brewing? 180 degrees Fahrenheit, baby. 82.2 Celsius. Now, some people like it that way, others wait for that shit to cool off a little before they take a sip. (Personally I think coffee drinkers weird for drinking coffee in the first place. You want to play tough, drink tea like I do. Tea is brewed at anywhere from 176 F [80 C] to 212 F [100 C or boiling]. Just sayin'.) Water at 140 F (60 C) can cause a second degree burn in three seconds. That same water, heated to 156 F (68.8C) will cause the same injury in one second.

Not a whole lot of difference there. You've noticed, I'm sure, how much cooler (or warmer) your house feels when the temp changes either way by only a couple degrees. The same is true of burns. The intensity of the heat and length of exposure are crucial, and seconds can make the difference between a first and third degree burn. More about the degrees of burns in a minute.

We've all had what are called contact burns. These are what happen when you touch something hot – a Crockpot, stove-eye, the dashboard of your car or the leather seats when you sit on it in short shorts in the summer, bare feet on hot sand…. Again, millions of examples. Also again, the degree of the burn depends on how long the contact was and how hot the object was. Most people jerk their hand away from something hot they've touched almost instantly (there are some medical conditions that keep people from feeling temperature changes and pain, but we're not talking about those right now), so contact is usually minimal, but occasionally you can't move fast enough, are pinned against something, the heat welds your hand to the object…you get it.

Let's talk a little about degrees of burns. You hear it all the time on TV. Most people know that third degree burns are the bad ones. And yeah, they are, but really, ALL degrees of burns are bad. Just because something is first degree doesn't mean it won't scar or that it won't get infected (yes, burns are wounds, either open or closed, and they can get infected in a number of ways - more on that when we talk about infection).

First degree burns are the superficial ones. They only involve the outermost layer of skin - the epidermis. It's red, but there aren't any blisters. It hurts and takes a week or two to heal. Most sunburns are first degree burns.

Second degree burns are just what they say - they move into the second layer of skin. These usually have blisters, and blanch (turn from red to white/go bloodless) when you apply pressure to them. Sometimes they hurt, sometimes not, and usually take anywhere from two weeks to two months to properly heal, if they don't get infected. Some sunburns are second degree. (Blisters, it's second degree.)

Third degree burns go through all the layers of the skin. It's stiff and white and doesn't blanch at all. They generally don't hurt at all (because there aren't any nerves there to conduct pain) and will take months to heal, if ever. They require surgery and a vast amount of treatment.

You don't hear about it a lot, but there is a fourth degree of burn. These burns go all the way through the skin, muscle, and bone. They're black and charred and there's no fixing these. They don't hurt (there's nothing there to hurt), they don't bleed, and they always require surgery - usually amputation - if, and only if, the person burned this badly survives.

Burns cause a lot of damage, not just to the part that was burned. Which leads us into the types of non-thermal burns.

Chemical burns are a complete bitch. These are caused by strong acids or alkali. These are a bitch because even after you get the chemical off or out of you, they continue to cause damage until whatever's doing the damage is rendered inert. Alkali substances usually cause more severe injury since they react with the natural oils in your skin and don't wash off with water. They literally seep into your pores. Examples are battery acid, bleach, ammonia, toilet bowl cleaner…basically any fucking chemical you can think of. You ever heard of a MSDS form? Most places that use chemicals are required to have one on file for EVERY SINGLE CHEMICAL THEY HAVE ON THE PREMISES. Even shit like hydrogen peroxide. Sure, basically harmless, but still. You get that shit in your eye, you're not gonna like it, and a MSDS sheet says everything about what that chemical does and how to deal with it if anything happens involving it.

Electrical burns are exactly what they sound like. It's contact with electricity. Remember when I said they were also thermal burns? They are, only they're from very high heat. Electricity burns a lot hotter than fire in a lot of cases and does a lot more damage. Sources of electricity range from the AC power in your house to DC power found in solar cell panels. (Hint – DC [direct current] is lower voltage than AC [alternating current]. This little bit of info is what pissed Thomas Edison off and led to the invention of the electric chair. I shit you not.)

Now, electric current isn't picky. That shit goes wherever it's easiest to go, and hurts like motherfucker. The contact/entry site/stingy part is the LEAST of your problems. Electric shock can stop your heart, (what did I just say about the electric chair? This is also why they use electricity to start it again, called "defibrillation." Pacemakers also use tiny electric shocks to "shock your heart back into rhythm."), fuck up your brain, screw with your motor function…anything to do with your body's own electrical system (yes, you have one, after a fashion) can take a hit. You can't tell by looking how badly you're hurt when you've taken a literal shock to your system, so you get shocked, you get your bitch-ass to a hospital NOW so they can check you out. Now, I'm not talking about little static discharge shocks like when you scuff your feet across a carpet and touch a doorknob. Everyone does that, and yeah, it's annoying and uncomfortable, but that's not going to hurt you. It will just piss you off enough to take the maintenance man's drill to the doorknob like a gangsta. (Beating up the printer is another issue.) I'm talking high voltage, which is more than 1,000 volts. You wouldn't think of a lightning strike as being low voltage, but in reality, yeah, they are. Most lightning strikes are under 1000 volts. Also, it's the speed of lightning strikes that's the key issue, not the voltage. Lightning strikes are fortunately rare, and while the aftereffects of them can be highly intense and very interesting, none have been known to convey actual real-life superpowers. To date, anyway.

Now we'll move on to the last type of burn.

A lot of writers get into trouble when they use radiation for things, because of comic books and movies. Radiological burns are caused by…you guessed it…radiation. All kinds. Alpha, beta, gamma…all of them will burn you. Most of them require decontamination to cope with before they stop burning, then there's radiation sickness to deal with. Now, like anything, radiation can be used for good or for evil. The place in the hospital where you get your MRI, CT scan, ultrasound, or X-ray? Radiology. (Many people confuse nuclear medicine with radiology, when actually the two are in the same area. Nuclear medicine is a division of radiology, not separate from it.)

High doses of radiation can, quite literally, melt your face off. But that's an extreme example, and you kind of have to be in the middle of a nuclear fallout in order for that to happen.

Most of us have had radiation burns before. We just call them something else – sunburn. Yep…the sun delivers ultraviolet (NOT "ultra violent") radiation in varying dosages in different parts of the world, and if you're not careful/are exposed too long, you'll get a sunburn. (Or tanning booth burn.) Welding can also deliver this type of burn. Cancer patients sometimes go through external radiation therapy, and radiation burns are sometimes a side effect.

Radiation burns need to be kept in mind most frequently for writers, because they're so easy to get. Have a character baking in the sun? Give that bitch a sunburn and some aloe vera. (Hint: people of all skin pigmentation can get sunburn. It's just more noticeable on those with fair complexions. It hurts everyone equally.) Have a character working as a welder? Sparks fly. Literally. And they hurt on bare skin. Next time you meet someone who welds, look at their arms. You'll see a series of little round scars – these are burn scars from sparks.

And there you have it. Lots of ways to torment your poor character via burns. Maybe they get in a hurry and burn their tongue on a hot cup of tea. Maybe they stay out in the sun too long. Maybe they have cancer and need radiation therapy.

If you have your character run into a burning building for whatever reason you've got them doing that, they may get burned in addition to smoke inhalation, falling debris, chemical exposure...

...but that's a post for another time.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

Tuesday, June 4, 2013

Series Post: Ask Dr. Dina - Cuts and Punctures

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

Hello Evil Readers! I have returned!

Welcome back to the Ask Dr. Dina series of posts covering medical issues in your writing.

For those just joining us for this series, so far we've covered:

Loss of Consciousness

Altered Levels of Consciousness

Broken bones

Sprains and strains

and

Bruises

Today we're going to talk about more types of soft tissue injuries – lacerations and puncture wounds.

To clarify, a "laceration" is fancy medical speak for "cut." Cuts are open wounds (as opposed to closed wounds like contusions – "bruises"), and their depth is extremely important. They can be as shallow as a minor scrape (called an "abrasion," which can bleed or not depending on severity) to a wound that involves every layer of the skin and organs beneath it, like a gunshot.

Now, a laceration is different from an incision. Lacerations have jagged edges and are made by tearing/ripping rather than slicing. Razors, scalpels and even glass shards all make incisions – clean-edged cuts rather than torn. The difference is crucial when it comes to repairing/cleaning these wounds. Surgical cuts (incisions, NOT lacerations) are vastly different from cuts made by injury. Yes, they're damaging, but not nearly as much as traumatic ones. The clean edges of incisions are neater, leave less scarring and heal much faster than ragged ones. For the purposes of this post, we're going to talk about the former type of cut – lacerations.

Gunshot wounds (abbreviated in medical charting as "GSWs"), stabbings, car accidents, falls, trauma of any kind…all can involve lacerations. As I said above, the depth is the important thing. A cat scratch or a paper cut isn't likely to need stitches (though there are exceptions, I know), but then again, some gunshot wounds don't, either. It just depends on where the wound is and how it was made. (We'll talk about infection and wound care in another post.)

The injury itself is bad enough, but the repercussions of that wound is just as important to consider in your writing. If you have your hero shot, you'll need to take that into account. Where was he shot? In the abdomen? Well, there are lots of organs and some huge arteries and veins running through there. Depending on location, he could bleed out in a matter of minutes, or die from sepsis a week later if he doesn't get treatment for the bowel that got nicked. You have to take these things into consideration (I'm looking at you, Hollywood) when you injure your hero.

By the same token, shooting someone doesn't necessarily take them out. Again, it depends on where the wound is and how severe it is. There are things called "in and out" gunshot wounds, in which the bullet goes completely through the body. No bullet to extract (and for the record, you're not going to die from lead poisoning if you don't get the bullet out immediately). Just a hole and anything else it might have damaged passing through. Some bullets do serious damage, others just make the ER doc roll their eyes. (Trust me on this; I've been there.)

Another note about bullet extraction – sometimes it's best to leave the bullet where it is until you can get professional help. It's the same principle as a stab/puncture wound – LEAVE THE OBJECT WHERE IT IS. Why? Because it could be holding back hemorrhaging. Remember we talked about hemorrhage? Yeah, that's fancy medical speak for "bleeding," and if you pull that bullet or stake or piece of glass or metal or stabby object OUT of the wound, you could bleed out before help comes. LEAVE THE OBJECT. I know it's all macho and shit to have the hero pull the knife out of his stabbed wherever and use it on his assailant, but medically? Yeah, bad idea. Looks cool, though, so you're free to take a little creative license on this one. (See, this is why I write paranormal – I don't have to take this crap into account with immortals.)

Which leads us into puncture wounds. Here, have a graphic that shows you the difference between laceration and punctures.

Punctures are the worst possible wounds to deal with. They're messy, usually deeper than they look, nick things under them and are SERIOUSLY prone to infection. They're hard to repair, hard to heal…everything about puncture wounds sucks.

Punctures are caused by pointy objects – splinters, nails, knives, teeth, knitting needles…what have you. Sometimes they bleed, but sometimes (deceptively) don't, leading the person to believe they're not seriously injured when yeah, they really are.

Here's a trick about puncture wounds – if it's more than ¼" in depth, GO GET HELP. Home first aid isn't enough in these circumstances, because most home first aid is only superficial. That wound needs professional cleaning and possibly packing with antibiotic gauze or other type of repair. Just because you can't see any dirt or debris doesn't mean it's clean. This is especially true for facial/scalp wounds (which bleed a hell of a lot even when they're shallow).

Sometimes puncture wounds don't even hurt, because they're so fast and deep you don't know you're hurt until you realize you can't feel anything around the area. Also, just because you can't feel it hurting doesn't mean the puncture hasn't hit the bone.

Punctures are nasty, nasty things, especially stepping on a nail, hooking yourself with a fishhook or getting bitten by an animal (this includes humans, by the way). If you have your hero getting savaged by a wild beastie, there's going to be problems with those wounds later (besides the obvious lycanthropy, zombification, and whatnot), and you need to take that into account as a writer.

While regular tetanus shots have cut down on reported cases of tetanus by 95% (and cut deaths from tetanus down to almost zero), punctures remain the number one source of tetanus infections. (Or as the CDC puts it, "inadequate wound prophylaxis.")

Now, I'm not saying you have to give your hero's vaccination history in your writing. I'm just saying it's something to think about. If you have your hero in the ER with a puncture wound, they're going to ask if he has a current (in the last 10 years) tetanus shot, and if he doesn't, they'll give him one there.

Because that's adequate wound prophylaxis.

Also, if you, the writer, haven't updated your tetanus injection in the last 10 years, it wouldn't hurt you to do that. Because you never know when someone is going to stab you with a knitting needle. Or if you'll get bitten by a domestic or wild animal out on your run tomorrow.

That's it for this edition of Ask Dr. Dina. Next time we'll talk about burns. Or maybe wound care/infection prevention. We'll see. I'm open to suggestion.

Stay tuned!

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

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