Medical Advice for Your Writing Found Here

[Breezy]

Chickenpox

For the most part your description of chickenpox is spot on. It is a highly contagious viral infection with a rash characterized by itchy, blistering red spots. It does usually resolve within 2 weeks if not sooner.
A few points:
Isolation can be as simple as wearing gloves, gown, and mask and sanitizing surfaces with boiling water or bleach. It's not airborne, so they don't actually need to be isolated to the point where no one can see them. A simple face covering and barriers between your skin and the infected person's is sufficient to prevent the illness.
Itching can be prevented with mittens. This is a great idea and much better than encasing them in a blanket. That's just going to make their fever worse and dehydrate them. Speaking of which:
Hydration: Absolutely the more water the better.
Rash: Viral infections do not cause pus formation (particularly not yellow-green pus). A secondary bacterial infection of a varicella rash could cause white (barely yellow) pus to drain from the blisters but this is pretty rare. It's more likely if the patient is colonized with staph and scratching, so points for accuracy there. Bacterial infections are treated completely differently and are typically more deadly and not self-limiting (like most viral infections).
Seasonality: Viral infections have hardly anything to do with the weather. This is a common misconception, so you can keep the part where she says, "more likely to get it when it's really hot", but just know, it's not true. Extreme heat actually deactivates most viruses, including the varicella virus, which is why summertime is when you are least likely to contract chickenpox. Peak times for chickenpox are in the winter and spring when people are gathering indoors and traveling more (think Christmas, spring break, etc.). This is related to population behaviors during those months, not the weather.
Homeopathic Treatment: There is not evidence to suggest ingesting chamomile will decrease the infectious period of varicella infections. Chickenpox is self-limiting, meaning it does not require any specific treatment, however there are several herbs I suggest that may facilitate recovery. First are the standard immune boosting herbs: elderberry, vitamin C, and zinc. Second are the antiviral herbs, specifically those that have been studied in varicella: licorice and lemon balm leaf can both be made into teas and administered every few hours. Both can also be made into topical salves which can ease pain and reduce severity. Both of these herbs have good evidence surrounding their antiviral properties, including protein denaturing and mRNA replication disruption. Honey applied directly to the skin also has antiviral properties and can help sooth itching.

Overall, great job. The only things I would change are the pus (unless you really want to go the secondary bacterial route), chamomile to some other herb I mentioned, and maybe the part about hot weather increasing infectiousness (but this isn't something most people know, so eh.)

[AlydaB]

Wow- I just discovered this thread and I'm amazed by how thorough and well-thought out your responses are and that you've kept up with it for so long. Thank you for taking the time to help others improve their stories! This is an absolute blessing for us writers who don't know the first thing about anything medical-related (i.e. me lol)

I have two significant and spoilery scenes planned for my story that will cause severe injuries for some characters, so I'll avoid mentioning names/genders/context. I've done some research and consulted a nurse friend, but haven't decided exactly how I'll write them yet nor worked out a good, non-hokey balance between the realistic consequences and the life-saving magic of an ancient fantasy kingdom setting. Any advice?

One scene has a fighter break a couple ribs, a few fingers, and lose an eye when it's slashed by a blade, then spends a period recovering and learning to adjust. After those injuries, what would recovery look like and how long would it be before the character could fight/be active again? Does a slashed eye always need to be removed, leaving an empty socket? (I've seen several half-blind characters in fiction with slashed eyes that simply turn cloudy and blind and always wondered how realistic that is)

The other event has a character go into a coma for several months (edit for context: due to a head injury, is also beaten and stabbed multiple times). Considering the fact that it's so long-term and involves a developing young person, I know a full recovery and regaining their pre-coma mobility would be impossible in reality, so I intend to apply magical healing generously here. Nonetheless: What would the character's care while comatose look like? What would recovery look like?

Though magical healing is magical and the fact that my characters aren't human gives me leeway, I don't want this to negate the impact of their injuries. I'd like these scenes to have weight, impact, and consequences, with time devoted to healing and adapting to long-term/permanent effects... but also need my characters to regain enough functionality to eventually participate in the action again.

[Breezy]

I just discovered this thread and I'm amazed by how thorough and well-thought out your responses are and that you've kept up with it for so long. Thank you for taking the time to help others improve their stories!

Aw!!! You're so sweet.

[Breezy]

One scene has a fighter break a couple ribs, a few fingers, and lose an eye when it's slashed by a blade, then spends a period recovering and learning to adjust. After those injuries, what would recovery look like and how long would it be before the character could fight/be active again?

As long as the fractures to the ribs and fingers are all simple (meaning they don't puncture the skin or any internal organs) they will both heal on their own without any intervention within 6 weeks. They can definitely fight after that, no problems. You can brace the fingers, but it's not really necessary. Ribs we do literally nothing for, except advice them to not lift anything heavy and brace with a pillow if they cough or vomit. I'm gonna skip the eye injury bit for right now and circle back around later.

[Manyana]

This and the other response are so helpful to me. Super thanks!! Thank you, thank you!!

[Breezy]

The other event has a character go into a coma for several months (edit for context: due to a head injury, is also beaten and stabbed multiple times). Considering the fact that it's so long-term and involves a developing young person, I know a full recovery and regaining their pre-coma mobility would be impossible in reality, so I intend to apply magical healing generously here.

Phew, ok, so comas don't typically happen with head injuries or being beaten or stabbed. I've talked about this before in this thread (somewhere?), but lose of consciousness is either a sign of an acute illness (infectious, liver failure, some rare autoimmune stuff) or increased intercranial pressure (ICP). Increased ICP does occur after traumatic brain injuries (TBI) if you are having a hemorrhagic stroke, i.e. a bleed inside the brain. This needs surgical intervention (usually removing a part of the skull to allow the brain to expand outside the closed box and drain placement to remove blood.) I suppose magical healing could help the body reabsorb blood faster and stop bleeding by repairing the damaged vasculature, but that would basically make the person wake up immediately. Often after surgery we will keep patient's sedated using medications while we treat other injuries or wait for ICP to go down (using a drain). Sometimes medically sedated patients can remain comatose for several days (rarely weeks) after we stop the medication, but this only really happens if we are using those medications for a long time (weeks to months). If you hear of someone "waking up" from a coma after a couple of months, this is because the physicians were giving that person sedating medication at some point. Bottom line, if a person is not on sedating medications and is 24 hours post TBI and they aren't waking up, they never will.

On the flip side, if a person is being medically sedated for months and regains consciousness, recovery for mobility is often fantastic. Hemorrhagic strokes rarely affect motor centers of the brain, more often targeting speech centers and decision making centers (frontal lobe of the brain: the part that makes you you). If the person is affected in the motor complex, physical and speech therapy in the months immediately following the brain injury can greatly improve outcomes. The brain is stupid plastic (adaptive) and injuring it is nothing like injuring the spinal cord. The reason TBI's are so scary, honestly, is because a lot of people just don't survive, don't ever "wake up", or have permanent personality changes afterwards (poor decision making skills and impulse control). Of course, lots of people have persistent weakness and balance issues that can plague them for life after a TBI, but way more fully recover motor function, particularly if they go to physical therapy religiously.

[AlydaB]

Thank you for the in-depth responses! This is super helpful and gives me a lot of good food for thought! :]

[Breezy]

What would the character's care while comatose look like? What would recovery look like?

Pretty sure I've covered this in the thread.... hang on... oh wow, I guess I haven't. That surprises me. Ok. Let's talk Care of Unconscious/Immobile Patients:

1. ABCs: Airway, breathing, and circulation are huge priorities in the care of unconscious patients. Almost universally, patients who are unconscious will be intubated and ventilated. This means a tube is inserted through the mouth (rarely the nose, sometimes cut straight into the throat although that's called a tracheostomy) into the trachea (airway). This is because unconscious patients are at risk for their airway collapsing and cutting off breathing. If they have any kind of respiratory problems (like pneumonia which is stupid common in unconscious patients) they also need to be ventilated to support their breathing. And of course, even if they are breathing fine and their airway is alright, they might not be circulating enough oxygen which is another reason we may mechanically ventilate them.
2. Skin: This is another zinger. Have you ever sat on your butt for too long and felt pain? That is because the arteries that are supplying blood to your skin are compressed for a long period of time, denying the skin of oxygen. If this happens for too long, it can cause a pressure ulcer (content warning for picture) to form at pressure points (most commonly over the coccyx and heels). In order to prevent pressure ulcers, nurses or nurse aids turn unconscious patients ever two hours. Some hospitals have specialty beds that can rotate patients or redistribute weight using variable air pockets, but people still need to be manually turned. We can also use pressure ulcer prevention dressings, which are these big pink form patches that go other the heels or butt and help redistribute weight over bony prominences. Again, you still need to turn patients to prevent pressure ulcers even with devices helping you. Turning them basically just involves tucking a pillow under their left or right hip or removing the pillow to lie them completely flat (three positions).
3. Urination: Of course you still need to pee when you're unconscious. We frequently use urinary catheters to catch urine and hang the collection back below the patient (using gravity to drain) on one of the bed's hooks as seen here. For people who are unconscious for more than a couple weeks we just use absorbent pads or diapers which we check whenever we turn them, because urinary catheters can actually cause infections (UTIs).
4. Defecation: Immobile patients often have constipation. Walking helps stimulate the bowels, so if you don't move, you often get constipated. Also, the drugs we use to sedate people cause constipation. So nearly all unconscious patients will receive stool softeners (like senna) every twelve hours. And of course, someone has to clean them up.
5. Eating: Not necessary unless you are unconscious for more than 3-4 days. Seriously, people worry all the time about us starving their family members, but we typically don't start them on a diet until day 4 or 5. We use kangaroo pumps to deliver liquid goodness (totally kidding it smells and taste God awful) through a tube that is inserted into the mouth or nose and passed into the stomach or small intestines.
6. Hydration: Sedated patients are more often than not over hydrated. This is another thing families worry about, that they really shouldn't. We give people so much medicine and they often retain water. However, we check sodium levels in the blood every twelve hours anyways, which will give us warning if they are dehydrated. Also, if they have a urinary catheter, we expect them to produce at least 30mL of urine every hour. If they are doing that, they are hydrated. If we do need to give water, we can do it through an IV (0.9% sodium chloride sterile water, often just called saline) or through a feeding tube (tap water is just fine).
7. Bed Baths: at least once a day, sometimes more often if they are real poopy. This just involves using wet wipes (think like baby wipes) to clean the skin.
8. Blood work: Typically we will do blood work on conscious patients every twelve hours for... lots of reasons. Hydration, electrolyte balance, blood oxygenation, kidney function, anemia, and just too much to go into, but yeah, unless a patient is stupid stable (meaning there has been no change in their treatment plan or blood work for 3 or more days) we will do blood work. This might involve sticking them with a butterfly needle or drawing blood from a catheter (IV).
9. Contractures: Immobility causes the muscles to contract and stiffen. We place patients in neutral positions to prevent this a much as possible, but if someone is truly immobile for months, they will need someone to move their feet, arms, and legs through range of motion exercises to prevent muscle spasticity. For a good image of what contractures looks like, just think about someone with a spinal cord injury. Basically everything flexes (fingers curl, biceps flex, wrists curl, knees bend, feet drop).

Hm... maybe that's it? I'm sure I'll think of more stuff later, but those are the big things.

[Breezy]

Though magical healing is magical and the fact that my characters aren't human gives me leeway, I don't want this to negate the impact of their injuries. I'd like these scenes to have weight, impact, and consequences, with time devoted to healing and adapting to long-term/permanent effects... but also need my characters to regain enough functionality to eventually participate in the action again.

As far as general advice for healing magic: This is a personal taste thing. I typically like healing magic that is time based, i.e. that speeds up the body's natural healing processes. Half of all medicine (probably more?) is just supportive care, meaning we just support the body while it heals itself. So if you can skip the "wait" that's typically better. But this is really dependent on the type of injury, because some of them will need "surgical" (maybe magical surgical) interventions.

I think "stitching" a wound closed is the biggest offender of "yeah, that's not real". I personally write wound closure scenes as healing from the "inside out" or "deep to superficial". Tissue will regrow at the base of the wound and gradually work upwards. It's always interesting to consider limitations to your healing magic. For example, maybe it can't heal infections. So maybe your "cleric" needs to first clean the wound with soap and water (don't use alcohol or hydrogen peroxide, just don't) before healing it to prevent it from becoming infected internally later. Or maybe your healing magic can't cure chronic diseases, like diabetes and heart failure. Or maybe it can't regrow limbs, but it can reattach them if they are present.

I'd be happy to brainstorm with you about magical healing, because it's one of my favorite topics when authors are willing to get creative!

[joannekwan]

Welcome back Breezy!
Since you mentioned simple fractures earlier, I thought I'd run a scenario by you!

So I have two characters lost in the wilderness. One suffers a more complex fracture of his tibia in that it does cause a slight bump along the shin-line of his leg. His companion finds a splint and wraps it tight to prevent it from moving. And then for a short while the injured character has to traverse the woods with a crutch until they get him a litter that he lays on.

How painful would a fractured tibia be and how long can it stay that way before medical attention is necessary to set it so that it heals correctly?

[Breezy]

Does a slashed eye always need to be removed, leaving an empty socket? (I've seen several half-blind characters in fiction with slashed eyes that simply turn cloudy and blind and always wondered how realistic that is)

Ok. Eye injuries... phew. I finally am circling back. A brief disclaimer, eyes are incredibly complicated and this is not my area of expertise, but I can give you a few basic principles to work off. For reference to the parts of the eye I'm going to talk about, I've attached this image:

Biggest point: depth matters.

Lacerations to the eyelids, conjunctiva, sclera, and cornea will heal without interventions, causing no permanent damage. These are the most common types of lacerations when dealing with slashing injuries, because the brow and cheek bones create a concave space for the eye which protects it from slashing motions. Damage the lens can be more severe, but lens replacement (often called cataract surgery) is a 15 minute procedure that easily can fix lactations to the lens.

If the damage is deeper than the sclera, puncturing the vitreous, then removing the eye is often necessary, depending on the width of the laceration. However, we can replace eyes pretty easily, so you don't need to have an empty socket for life and can regain full vision. If we don't replace the eye, we can surgically suture the retina closed and leave the native eye in place. You'll be blind (not true blindness, because you will still see light) and often won't have an iris (just a really big pupil), but you don't have to remove eye all the time, because as long as the blood vessels are intact, it's not going to hurt you. I can easily see magical healing being able to replace your eye with someone else's eye or repairing a damaged retina.

Any deeper than the vitreous and you risk damaging the macula and most horrid optic nerve. Damage to the macula will of course cause blindness, but again can be treated with eye replacement surgery. Optic nerve damage means irreversible blindness. Whether we remove the eye or not sort of just depends on how clean the cut was, how thin it was, and how much tissue of the native eye is salvageable. For cosmetic reasons it is always preferable to keep the eye in place if we can, but if we do remove it (because it's just too cut up to salvage) we won't do a transplant, because there is no point with optic nerve damage. However, you can have a glass eye which removes the need for an eye patch.

And speaking of eye patches: they are used to keep the eye protected and hydrated during the healing process. Often we use eye patches if there is damage to the eyelids or muscles of the eye, because we need to keep the eye closed while those areas heal.

A note about injuries to the muscles of the eye, those will obviously affect vision, but can heal spontaneously or through surgery as well. Or you might just have a lazy eye.

Finally, what causes white eyes? Not blindness. The classic sequence where the eye clouds over in seconds after a blinding injury is just wrong. White in the lens of the eye is caused by protein accumulation, called a cataract. Cataracts are more common in blind individuals, which is why we often associate them with blindness, but not all blind individuals will necessarily develop cataracts. There are other conditions that can cause cloudy appearance in the eye (scar tissue as seen in the retinal repair image I attached above), but the most common reason is cataracts.

[Breezy]

How painful would a fractured tibia be and how long can it stay that way before medical attention is necessary to set it so that it heals correctly?

Hmmmm.... well, everyone's pain tolerance is different, but I think it is reasonable to be able to walk on a fractured tibia (with crutches to avoid further injury is exactly right). Lots of people won't want to, but you can. I've walked on a broken bone before and was fine, but I think(?) I have a pretty high tolerance. As a funny side note, gingers typically have lower pain tolerances. This isn't anything against gingers, but actually something that has been researched in medicine. As another side note, the most painful period will be days 0-5 (refer to hematoma phase in image below).

As far as how quickly they need medical attention: not quickly at all. As long as you stay off the leg (use crutches or stretcher) you can go two weeks or longer before needing surgery. In the image below, we typically will want to set the bone before the hard callus forms. It's actually pretty common to hold off on surgical repair of bones in the hospital if the patient is too unstable to have surgery (i.e. they have something else going on that's life threatening). I've had patients go days and even weeks before they are ready to have surgery.

[joannekwan]

Ooh that timetable helps a lot! Thanks so much!

[NickRowler]

Some of the conditions you listed don't really match with what I want. All I can say about my character's condition is that his brother also has it.

I was thinking of maybe making it sun damage. The character is suppose to be a carrier for albinism so it might make sense if he was also sensitive to the sun.

[UrMom]

Wow, I don't know why I don't remember seeing this. I have so much I want to ask, there's a fair amount of medical stuff in my comic, but I'm also nervous because I wouldn't be able to go back and fix anything. (Traditional medium comic, a page takes a week to finish.) So I would just have to live with the embarrassment of my ignorance. :'D

I guess the main question, which would really mess up my whole comic if whatever research I was able to do is wrong, is it possible to survive for a few years with HCL without treatment? Granted, I imagine there would be emergency trips to the hospital and such, and it could be based on the person's overall health. I have a character who gets diagnosed a little over 5 years before the main story.

Also this character is later on diagnosed with multiple tumors, I wanted to have a chemo port be the method of treatment, but would that be the wrong decision? Also would they need a different method of treatment for the HCL if I'm able to use that? I've done as much research as I could, but I admit I'm not the best with understanding the terminology, or knowing exactly how to search of similar scenarios to base my character stuff off of.

You totally don't have to respond to this if you don't want to, I imagine it would be a lot to ask. Either way, I really appreciate all the time you've put into helping folks. Even though I'm too lazy to do more than casual medical research I actually really like the subject, so this thread will be a fun read for me.

[Breezy]

is it possible to survive for a few years with HCL without treatment?

Hairy Cell Leukemia: Goals of care for HCL are to alleviate symptoms, reverse cytopenias, and provide periods of remission. Treatment is not curative, but most people with HCL will live near normal lifespans. Many patients with HCL are asymptomatic at the time they are diagnosed. This means they don't have any symptoms of the disease and don't need any treatment. This asymptomatic period can last for years, so I think it is completely reasonable to say your MC has never been hospitalized or received treatment in the last five years.

Infections: The main cause of hospitalizations, symptoms, and death in HCL is infections. HCL decreases the number of red blood cells, white blood cells, and platelets in the blood. In particular, low neutrophil count (WBC) makes these patients susceptible to frequent and severe infections. If someone has an active infection, we always treat that before starting chemotherapy.

Chemotherapy: After any infections have cleared, the MC certainly can receive chemotherapy (usually cladribine plus rituximab). This is not curative, but will temporarily alleviate pancytopenia (decreased number of blood cells of the three types I mentioned above). You certainly can use a vascular access port to administer cladribine, but it is probably not necessary, because treatment lasts only 5-7 days. I would just place a PICC for this, but it's sort of patient and situation dependent. If the patient is having frequent relapses, then a port may be indicated. However, most people don't relapse within 2 years of treatment and tunneling a port is a site for infection, so it's sort of a risk/benefits analysis and patient preference to determine whether to do it or not. If the patient does relapse, they are usually just treated with another round of cladribine. Rarely do they need any other forms of chemotherapy.

Metastasis is really rare with HCL. Very rarely it can lead to tumors in the spleen, but it's pretty uncommon. However, individuals with HCL are at higher risk for developing other forms of unrelated cancer. Treatment for unrelated tumors will be based on where it is and what type they are, so I'd need specifics to comment on that. Bottom line, if your MC is going to die, it's going to be from a raging infection, not metastasis or other cancers (most likely).

I really appreciate all the time you've put into helping folks. Even though I'm too lazy to do more than casual medical research I actually really like the subject, so this thread will be a fun read for me.

Honestly, I love doing this and I'm so happy it is appreciated! I think you did a great job with your research. Overall 9/10 accuracy!

[UrMom]

Ooh my god! Thank you so much for this info, it's nice to see a name for the treatment and what you would do, I knew it would be a specific type but I didn't know how to find what it would be called. I always just see "chemo", and it doesn't help that most fiction tackling the subject are so vague on the treatment and such. It's also nice having this information directed at what I'm trying to do, if that makes sense. As well as knowing I didn't do as bad with the research as I thought, it's something I really want to do a good job with since the story is important to me, want everything to be somewhat accurate.

The tumors are indeed unrelated. This character has early-ish stages of lung and gastric cancer relating to their history of smoking, poor eating habits and overall neglect of their health. Basically they're a hot mess. I didn't want to overload you with questions since I was taking time from you with the HCL questions, and honestly I'm still just getting into the details of these since they're not addressed till later on... like, two or so years from now 'later'. (I don't quite know what to ask yet.) Right now there's just implications of possible symptoms since the character doesn't even know. So far there's breathing issues, bloody phlegm, stomach pain, weight loss and nausea.
Although if none of that works together then feel free to let me know, it's early enough where I can change these things.

Honestly, I love doing this and I'm so happy it is appreciated!

Absolutely appreciated! It's not often when someone with knowledge in a certain field volunteers their time to help creators with their work. Especially someone in medical, that's a demanding, busy job.

[Breezy]

The character is suppose to be a carrier for albinism so it might make sense if he was also sensitive to the sun.

Albinism is an incredibly rare genetic disorder affecting the genes responsible for melanin production in the skin, hair, and eyes. Worldwide, albinism affects only 1 in 20,000 individuals. For a reference, the average American only meets 10,000 people in their entire lifetime. This means many of us may go our entire lives without ever meeting someone affected by albinism. Additionally, this condition is more common in African populations and countries (but still stupid rare). Our bodies only need one gene to produce melanin, so this disorder is an "all or nothing" recessive disorder. Carriers of the mutated gene will show no symptoms and will most likely never know they have the disorder. They are not more sensitive to sun, and if they are of African descent they will obviously be even less sensitive than a Caucasian. Albinism is primarily a disorder of the eye, not a cosmetic disorder. A key feature of Albinism is vision impairment. This is such an important part of the disorder, it is actually included in the full name: oculocutaneous albinism. We often think of only the "cutaneous" (skin) part of the disorder, but most of the disability and health problems come from the eye complications associated with this disorder. Of course, people with albinism are also more prone to freckles, moles, and skin cancers which will all appear red, rather than brown.

General Principles About Discoloration: As a general rule about non-infectious, non-painful skin discoloration, brownish-reds will typically indicate sun damage while purplish-reds indicate vascular (blood vessel) damage. Port wine stains, for example, which we already discussed, are caused by very small blood vessels (capillaries) near the surface of the skin being swollen and malformed. That's why it can get worse over time (as the malformation and swelling worsens), but is a congenital disorder (because the malformations develop in utero).

The disorder that is closest to port wine stains might be granuloma annulare. It is triggered by sun damage, but is an autoimmune disorder. It causes large, purple/red spots as seen below:

[NickRowler]

You don’t need to explain albinism to me, I know what it is.

I have seen several people with it. Probably at least 10.

[Breezy]

I figured you knew, but I always like to give information for the people reading through the forum and sometimes can get overzealous in my explanations. I apologize for making it sound like you didn't know. As a side not, that's pretty incredible that you have met so many people with albinism! I'll be honest, I've never met anyone affected by that condition, but I guess that's just the way statistics work; nothing's guaranteed.

Sorry if I could not give you more helpful advice on what type of skin condition your MC might have. I keep racking my brain trying to think of something that might look like a port wine stain, but develops later in life... Oh well, maybe it's just magic. If your world is fantasy, then it can be anything you want. Actually, even if it is not fantasy, the world is yours to create.