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Category Archives: Medical History

Heartbeats and Art

First a little semantics: Arrhythmia actually means “without rhythm.” So the only true arrhythmia is asystole or cardiac standstill, which means the heart has no rhythm and simply sits there quietly. Not a good thing. Not compatible with life.

The proper term is dysrhythmia, which means an “abnormal rhythm.” There are many different types of these.

Some are slow:

Sinus Brady

Others are fast:

SVT

We all have dysrhythmias but most of us are totally unaware they are happening. Other folks experience palpitations—-an awareness of a cardiac irregularity. These can sometimes be alarming and I regularly see patients in my office with this complaint.

Beethoven

But can your heart’s rhythm effect your creativity? Did a dysrhythmia contribute to Beethoven’s musical prowess? Did Shakespeare’s heart beat in iambic pentameter?

As a cardiologist, I’m not sure I buy into this but it is intriguing:

http://www.medicalnewstoday.com/articles/287809.php

 

Medicine Is Strange: Stone Man Syndrome

f1

Medicine has a lot of very strange disorders in its catalog of maladies.

Fibrodysplasia Ossificans Progressiva (FOP or Stone Man Syndrome) is one of them.

http://thechirurgeonsapprentice.com/2014/12/17/disturbing-disorders-fop-stone-man-syndrome/

 

Q and A: Could Death From Bleeding Be Delayed For Several Days After a Frontier Wagon Wheel Accident?

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

wagon_train-2

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train may have seen similar injuries in the past and may know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going live and then be very shocked when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. They train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

 

Murder By Meme: Slender Man and the Wakefield Anti-Vaccine Hoax

Slender Man

We all know that viral illnesses can kill. Ebola would be an example. So would small pox and the 1918 Flu.

But can an internet viral hoax kill? An interesting article titled “Murder By Meme: Slender Man and the Wakefield Anti-Vax Hoax” by Travis Langley, Ph.D. in Psychology Today looks at this issue.

In June, 2009, Eric Knudsen (aka Victor Surge) posted a pair of black & white photos of groups of children in which he had inserted a thin figure in a black suit into the background. This was the birth of the Slender Man hysteria. It led to the attempted murder of a 12-year-old girl by two of her classmates, also 12. Why would they stab their classmate 19 times? Apparently to serve as “proxies” for The Slender Man and to show that he really existed.

Crazy is as crazy does.

And then there’s the 14-year-old who read about Slender Man and decided she needed to burn down her home—-with her mother and brother inside. Fortunately there were no injuries but the house and family car took a hit.

But such internet hoaxes aren’t confined to the world on teen angst. It has also entered the world of legitimate medicine. And has done great harm.

MMR

Ever seen a case of Whooping Cough? Diphtheria? Probably not. I’ve never seen diphtheria and whooping cough (pertussis) only a couple of times way back during my pediatrics rotation as a junior medical student. The reason these and other childhood diseases such a rubella and mumps are now not so common is a robust and widespread immunization program that has done a stellar job in keeping these illnesses at bay.

Enter Dr. Andrew Wakefield. He apparently created an entirely fraudulent research study that suggested that the MMR (Measles, Mumps, and Rubella) vaccine caused Autism. Based on this scam, allegedly funded by an “ambulance-chasing” law firm, many well-meaning and fearful parents refused to vaccinate their children. This led to outbreaks of these uncommon diseases. Here in my own backyard, Orange County, CA, we had an outbreak of pertussis that could be traced for the most part to a single pediatrician who bought into this “bad science.”

The truth? There is not a single piece of legitimate evidence to suggest that MMR is in any way related to autism.

And Slender Man does not exist.

 
3 Comments

Posted by on October 16, 2014 in Medical History, Medical Issues

 

Guest Blogger: Daphne Holmes: How DNA Testing Helps Determine Paternity

DNA

 

How DNA Testing Helps Determine Paternity

The impetus for determining the paternity of a child likely dates back to the most primitive tribal cultures. Particularly in patriarchal cultures where females were regarded as the property of males, it was deemed important to ensure that a man’s “property” had not been shared, and that the virtue of the female was beyond question. As societies became more sophisticated, the need to establish paternity became as much an economic issue as a moral one. In modern cultures, paternity testing is used primarily to establish whether or not a man is responsible for providing financial support to a child, as well as determining whether the child carries any of the father’s genetic predispositions for health challenges.

Physical appearance – In more primitive cultures (some of which continue to flourish), the objectives behind determining the paternity of a child were culturally and/or emotionally based. If a child was born who lacked identifying characteristics of either parent, it was frequently assumed that the father was someone other than the woman’s mate. The repercussions to the mother were quite severe, often culminating in her death. Unfortunately – especially for the women – the comparison of obvious physical traits was highly subjective, and many women suffered dire consequences, even if their husband/mate was indeed the biological father.

Blood typing – With the early 20th century discovery that different individuals had different blood types, and the recognition in the 1920s that those blood types were genetically inherited, a more accurate means of determining paternity came into common use. It was discovered that by comparing the parents’ blood types, it was possible to determine the most likely blood type of the child. While this was admittedly a step above the “he has his father’s eyes” paternity test, it was still only about 30% accurate.

Serological testing – It was discovered in the 1930s that specific proteins not considered during blood typing could establish the presence of genetically inherited antigens that would more accurately identify the child’s biological father. Unfortunately, serological testing only improved the accuracy of paternity testing to about 40%. Hardly conclusive evidence.

Tissue typing – In the 1970s, the human leukocyte antigen (HLA) was discovered in abundance within white blood cells. When samples of this genetically inherited antigen taken from the mother and child were compared to the sample taken from the father, paternity could be established with roughly 80% accuracy. While this was a significant improvement over previous methods, the collection procedure itself was unpleasant, and the size of the sample required made it hazardous to the child, particularly if the child was less than six months old. Obviously, more work needed to be done.

DNA testing (RFLP) – In the 1980s, the technique called restriction fragment length polymorphism (RFLP) was discovered that looked at a significantly wider spectrum of variables in the blood than had been analyzed with earlier techniques. It was discovered that the offspring of two parents would have half the unique characteristics of each parent. This technique elevated the accuracy of paternity testing to the level of statistical certainty. Unfortunately, the amount of blood required for accurate sampling was, like tissue sampling, large, posing potential problems for the child. In addition, the potential for genetic mutations in the child could render a false negative, indicating that neither the woman or the man was the child’s biological parents. For these reasons, RFLP testing has been all but abandoned.

DNA Testing (PCR) – By the 1990s, the RFLP testing was replaced by the polymerase chain reaction (PCR) technique. This technique involves the computerized replication of DNA collected from even a minuscule sample that is collected anywhere on the individual’s body, then comparing the subjects’ profiles. In addition to requiring a very small sample (typically via an oral swab), the subject is not submitted to discomfort as in earlier test techniques, and the computerized analysis takes far less time, while still providing accuracy at the level of statistical certainty, 99.99%.

Author: Daphne Holmes contributed this guest post. She is a writer from www.ArrestRecords.com and you can reach her at daphneholmes9@gmail.com.

 

 

Snake Venom For Treating Seizures? On Second Thought

rattlesnake

 

In the dark ages of medicine, meaning anything before 50 to 100 years ago, those afflicted with epilepsy were treated, how shall we say, less than compassionately. They were often thought to be infected by some evil miasma, or possessed by a lurking devil or witch or warlock, or were afflicted with some contagious process. They were isolated from society, feared and shunned by all, and often subjected to horrific treatments – everything from freezing water to cutting holes in the skull to let out the evil spirits (trepanning).

 

trepan

 

This is not an uncommon reaction when people are faced with things that they don’t understand. And 100 years ago the medical profession actually understood very little.

A case in point would be Philadelphia physician Dr. Ralph Spangler who suggested that rattlesnake venom, which interestingly he had been using to treat tuberculosis (go figure), might be useful in treating epilepsy. He published an article about a Texas man who had been bitten by a rattlesnake and subsequently the epileptic seizures that had plagued him suddenly ceased. In this empirical observation of a single case he jumped to the profound conclusion that snake venom cures seizures. Thankfully cooler heads prevailed and other physicians pointed out that snake venom not only didn’t, and couldn’t, help epilepsy but rather frequently caused allergic reactions as well as hemolytic destruction of the blood. Not pretty.

The history of medicine is replete with such examples.

 

Is “Real” Artificial Blood On the Horizon?

red-blood-cells

 

Blood is indeed the river of life. It carries oxygen and nutrients to all the cells of the body and removes toxic byproducts to keep everything clean and healthy. The cardiovascular system is a closed system in that it constantly recirculates, and like submarines, leaks from the system can be disastrous, and deadly. Blood is also a living, biological material and this makes it very difficult to handle. It must be taken from a living person, treated to prevent clotting, and stored in a manner that prevents decay. The logistics of this are very difficult, particularly when blood is needed in places such as war zones, very remote areas, and even in space. If someone is severely injured and in danger of exsanguinating – – the $10 word for “bleeding to death” – – then rapidly replacing this loss blood is essential. IV fluids and plasma expanders and other assorted intravenous materials can be given to buy time, to keep the volume in the system to an adequate level, and to keep everything circulating, but these materials have a major drawback – – they don’t carry oxygen. So the only life-saving remedy is to replace the blood.

Over the years there have been many attempts to develop artificial blood, a product that would carry oxygen and be logistically more friendly. Something that did not require anticoagulation, refrigeration, and care in its transport and storage. Something that could be carried and stored like a bottle of water. Many of these endeavors have proven to be unsuccessful.

Blood substitutes have traditionally been based on hemoglobin, the oxygen-carrying molecule within the red blood cells (RBCs). Products such as HemoPure (made from bovine hemoglobin), PolyHeme (made from outdated human blood), and HemAssist (based on cross-linked hemoglobin) all seemed promising but safety issues arose with each and these have not been completely resolved.

Other forms of “artificial blood” have been based on perfluorocarbon emulsions. These too have faced many problems.

Another problem with blood therapy is keeping a steady and safe supply. There are only so many donors and the blood’s shelf-life is not all that long. If blood could be manufactured so that an adequate and steady supply could be maintained, this would be a giant step forward.

Well, now it seems that manufactured truly artificial blood might be on the horizon. A group at the University of Edinburgh is beginning clinical trials on a process for making red blood cells from stem cells. Since these would be “real” RBCs, the technique holds promise.

 
2 Comments

Posted by on April 30, 2014 in Medical History, Medical Issues

 
 
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