The Medical Thread

Yes. It can lead to (relative) sodium deficiency. I remember years ago someone in Germany having a drinking contest and dying at the end due to I think electrolyte imbalance.

Drinking too much water can be fatal, yes. The electrolyte imbalance can result in cerebral oedema, raising intracranial pressure. There not being a great deal of room within the cranial cavity, the pressure can result in herniation of parts of the brain - in particular, tonsillar herniation or "coning". The cerebellar tonsils are forced through the foramen magnum and press against the medulla, which controls vital respiratory functions.

I don't really have anything to add, other than that I've seen a couple of cases of water intoxication in my short career. Fortunately, none have had the misfortune of "coning" on my watch.

edited 31st Jan '13 3:00:44 AM by Pyrite

That's bad in case you're wondering.

edited 31st Jan '13 8:34:20 AM by joeyjojo

Okay, that sounds bad enough.

I sure heard a lot about this tonsils thing but never really bothered to actually look it up until today. Harr harr harr.

Random rambling:

It is amazing how a person can actually function after getting a half of his/her brain removed. Damn weird, human body is.

Okay, so one of the characters in my book develops lung cancer. He's in a place where treatment for this (chemo, radiation, etc.) is unavailable. I have a few questions relating to this:

• About how long would one's expected life span be after this diagnosis? After a while, would it be completely unbearable, or could someone live relatively comfortable with painkillers until they pass?
• What are usual symptoms? Is it likely for the cancer to spread to other body parts after a while?

And I know there are SEVERAL types of lung cancer, but just take this as being for the most common type.

edited 13th Feb '13 5:15:02 PM by TheMuse

I think squamous cell cancer is the most frequent lung cancer.

Ah. This is going to be tricky to explain, but in a nutshell (and off the top of my head, so you might want to take it with a pinch of salt):

• We generally divide lung cancers into small cell (SCLC) and non-small cell (NSCLC) lung carcinomas - mainly because the approach to treatment is different. (SCLCs respond more readily to chemotherapy and radiotherapy, while NSCLCs may be resectable if caught early, but don't respond that well to the other two modalities.)
• Judging from the Wikipedia article (okay, okay...) adenocarcinomas are actually the most common, and a significant proportion (still the minority) are actually in non-smokers.
• Prognosis and life expectancy are a little hard to determine, and depend on the stage at the time of diagnosis. Without treatment, I'd say small cell carcinomas tend to be more aggressive (we're looking at about, say, 2 years tops). With metastatic disease - regardless of type - we generally quote a value of "months". An oncologist would probably be able to give you more precise estimates, but it varies.
• As for symptoms... Ah. (Non-comprehensive list coming up.)
  • If it's relatively early on, your character might probably start off with the Incurable Cough of Death, with or without Blood from the Mouth (okay, blood in the sputum). Or he might be relatively asymptomatic.
  • If the tumour itself becomes bigger, he might still remain relatively asymptomatic. But if the tumour blocks off a major airway (partially or completely), you might end up seeing recurrent episodes of pneumonia, or a collapse of the lung (usually presenting as chest pain and difficulty breathing). If the tumour ends up eroding into a major blood vessel, you get massive bleeding. And if it spreads to the pleura (the lining surrounding the lung), you may end up with a pleural effusion, which is what happens when fluid gets trapped between the lung and the chest wall. A large-enough effusion can also cause significant shortness of breath. EDIT: Forgot to mention local invasion into nerves (causing nerve palsies, e.g. Horner's syndrome) and vessels (e.g. superior vena cava obstruction, which can cause facial flushing, congestion and difficulty breathing, headaches and giddiness).
  • Some tumours are also known to produce paraneoplastic effects (they produce antibodies, hormones, etc. that affect the rest of the body, but not because of the local presence of the cancer cells). Small cell carcinomas are associated with Lambert-Eaton Myasthenic Syndrome (muscle weakness) and Syndrome of Inappropriate ADH secretion (headache, nausea, vomiting, seizures, comas); squamous cell carcinomas are associated with hypercalcaemia (kidney and gall stones, bone aches, abdominal pain, excessive urination, psychiatric symptoms).
  • And if you're talking about metastatic disease, most of the time we're looking at spread to the bones (pathological fractures, bone pain), brain (again, headache, nausea, vomiting, seizures, comas), and liver (jaundice, abdominal distension, abdominal pain) - and occasionally the adrenal glands (lethargy, nausea and abdominal pain, and drops in blood pressure - which can sometimes be catastrophic).
  • Of course, bear in mind that most if not all cancers, if progressive, will cause the patient to lose weight / appetite / energy and become significantly undernourished and lethargic.

Is it possible for your character to get by? Well, we have a fair number of terminal patients who do manage to get by with oxygen and painkillers. The tricky bit is that as the symptoms progress, your character will probably have increased requirements for both, and near the end, the lack of oxygen combined with the painkillers are more likely to make him drowsy or even unconscious (which, given the alternatives, can be considered a mercy).

Hope these helped. For more information, go check the Wikipedia articles on lung cancer, or the publicly-available medical resources such as the Mayo Clinic's page or PubMed Health.

edited 19th Feb '13 1:54:38 AM by Pyrite

That was extremely helpful :) Thanks

Random question.

What are some ways to temporarily disable someone's arm?

Hitting the nerves?

Oh yeah, that could work. Where, though?

I am thinking somewhere in the shoulder.

I'm assuming you mean something beyond "sitting on it"?

A major blow to the top of the shoulder, just above the joint could do it: that could numb everything below quite easily... not to mention make it bloody painful to try moving the whole thing too soon.

How desperately will they want to move, though? 'Cos never underestimate the power of emergency endorphins...

edited 15th Feb '13 11:06:03 AM by Euodiachloris

The scenario I am thinking is that a helicopter pilot injures his arms. He handles it by getting a civilian (albeit an aircraft enthusiasts with many experiences in flight simulators) into the cockpit and telling him instructions.

I am not sure how plausible this whole scenario even is. :/

On night shift, so here's one way. You compress or hit the shoulder from below, induce a radial nerve palsy. Dislocations are one thing, but nerve injury? You're going to have trouble moving that arm no matter what kind of adrenaline rush you have.

edited 15th Feb '13 1:46:57 PM by Pyrite

Hello thread watchers.

I'm a mod for a roleplaying group and we have someone who wants to submit a character who is intersexed. They appear to have done some research, and the other mod and myself have been trying to do research of our own.

Research of our own meaning wikipedia... http://en.wikipedia.org/wiki/Intersexed I asked the person if they knew which of the conditions the character had. The person replied that they would be a rare/true hermaphrodite. The other mod disputed this, saying that humans aren't capable of true hermaphroditism. The person links to articles saying that they are.

So I guess what I'm asking is, would that be possible? And if not, what specific type of intersex would result in the character

1. Mostly appearing female, to the point of being able to pass off as one (They look like they have pretty normal looking breasts in the drawing as well as hips?)

2. Having both sets of sexual organs

3. It's not specified how much is down there, just that a doctor was confused about the character's gender when they were born

4. It's also not specified what, if anything, is functional

5. The character also hasn't had sexual reassignment surgery of any kind. It was offered, but the character's parent refused.

edited 18th Feb '13 9:02:16 PM by Hermiethefrog

I recall seeing in OMIM such a thing under SRY.

(Apologies in advance if I end up offending anyone.)

Oh, dear. This is going to get very, very tricky.

I'd search the literature if I had time, but unfortunately, I'm not feeling too well today and sexual differentiation is a subject which I'm really not well-versed in, so I'll just break down the stages of sexual development and explain why such a scenario is most probably not biologically feasible. (Again, cribbing off Wikipedia - it's been a while, and my memory of the details is a little fuzzy.)

Stages of sexual differentiation:

• Stage 1: Chromosomal. Typically XX or XY, although you have your chromosomal non-disjunction syndromes like Kleinfelter's (47XXY) and Turner's (45XO). If you have more than 1 X chromosome, the genes on only one are expressed. Expression of genes on the Y chromosome are responsible for development of male gonads.
• Stage 2: Gonadal. Genes on the Y chromosome stimulate germ cells to develop into testes. In their absence, germ cells become ovaries, but you need 2 X chromosomes for them to develop properly or you'll get underdeveloped ovaries ("streak" ovaries).
• Stage 3: Hormonal. Once the gonads develop properly, they produce hormones which will stimulate the development of the reproductive tract. Male gonads produce testosterone and Anti-Mullerian hormone (AMH) for the development of the male internal reproductive tract.
• Stage 4: Development of the internal reproductive tract. Usually occurs before the 1st trimester of gestation. Testosterone and AMH cause the development of the typical male internal reproductive organs (sperm ducts and vesicles) and ensure that the typical female internal reproductive organs (uterus and Fallopian tubes) do not develop. Testosterone manages the former and AMH the latter. Absence of male hormones leads to the development of typical female internal reproductive organs. Mutations or varying levels of said hormones can result in malformed or ambiguous internal genitalia (e.g. presence of both a uterus and undescended testes).
• Stage 5: Development of external genitalia. Usually occurs after the 1st trimester. Also dependent on hormone levels - androgens cause the development of external genitalia into the penis, scrotum, prostate (I think), and the other relevant bits of male genitalia, and descent of the testes into the scrotum. Their absence causes genitalia to develop into female genitalia - the labia, clitoris, vagina etc. Androgen insensitivity or insufficient androgen levels can cause ambiguous genitalia - or in complete androgen insensitivity, result in fully-developed female external genitalia but with a pair of undescended testes instead of a uterus, Fallopian tubes ovaries.
• Stage 6: Secondary sexual characterstics and pubertal development. At puberty, the presence of androgens / estrogens ("male" and "female" hormones) cause the development of male / female secondary sexual characteristics, further development of primary sexual characteristics (e.g. penis / testicular development) the onset of menstruation, and other associated physiological changes. Insufficient or excessive levels of these hormones respectively result in underdevelopment or hyperdevelopment of these respective characterstics.

In medical parlance (actually, I'm not sure if we still use the term) true hermaphrodites are defined as having both testicular and ovarian tissue (Stage 2) - either both ovaries and testes, or mixed tissue - and the outcome is dependent on the hormone levels produced and which one predominates. But when your player refers to true hermaphroditism, based on the characteristics shown, I assume they refer to Criteria 2: "Having both sets of sexual organs". The question is, what does your player define to be "sexual organs"? Ovaries and testes? Internal genitalia? External genitalia? And what exactly is down there and / or functional (Criteria 3 and 4)? Your player is going to have to be specific if we're going to try to make this medically accurate.

I assume that your player would probably be thinking of fully-functional external genitalia (since nobody in an RP is going to be concerned about what your internal organs look like... unless this is going to be a major plot point in the future). This is probably physically impossible, since there's only one set of structures that will develop into external genitalia - either male, female, or indeterminate (Stage 5 - 6), the latter of which will cover cases such as virilisation of female genitalia (e.g. clitoral hyperdevelopment), which is the closest scenario that I can think of (which is nowhere close). To complicate matters, in order to be physiologically female in terms of secondary sexual characteristics (and avoiding masculinisation), you'd need sufficient circulating estrogen levels and sufficiently low androgen levels, so the closest situation I can think of is a scenario where a patient with indeterminate genitalia receives hormone therapy, but even that would be way off the mark. Hell, I don't think I could even handwave it as a vestigial fraternal conjoined twin of opposing sex (which, while theoretically possible, is probably unheard of and will not give the desired results).

So the only way we're going to be able to justify this is if A Wizard Did It.

(Footnote: This is a purely biological discussion. Gender dysphoria in intersex patients is another whole can of worms which I am even less qualified to talk about.)

edited 19th Feb '13 5:25:20 AM by Pyrite

I have to go with the other mod on this one.

While there have been a lot of recorded cases of non-standard chromosomes sets and ambiguous genitalia development. There has not been in the history of medical knowledge any confirmed cases of a human being having a fully functional set of both male and female genitalia.

...A man can dream though... A man can dream.

edited 17th Apr '13 5:53:21 PM by joeyjojo

Dude, take your dreams with you to the Nunnery. We don't need them here.

Pyrite, Joey, thank you both for your responses on this!

Regarding the stages, since the person specifically mentioned the character having the external organs, I would assume the character is either at a stage five or a stage six.

I, however, have no idea what they mean by both sets. There wasn't any mention of internal organs such as ovaries or testes and whether those are functional or not. I assume the person with the character hadn't really considered that. If they mean hermaphrodite as in both testes and ovaries, then that would clear that up.

The option you described with the character having indeterminate external organs and receiving hormone therapy and the secondary sexual characteristics being a result of that seems like the most logical for the situation.

I personally wouldn't allow for the character to have both sets of external organs fully functioning. I can't hand wave that as a wizard did it. The setting for the roleplay is supernatural and yes, I can allow werewolves, vampires, fairies, and ghosts, but I have my limits. I doubt the character's condition is a result of anything supernatural, magical, or otherwise weird anyways.

(And on the footnote, I sincerely doubt the person had considered that either. It wasn't mentioned anywhere in the bio. Eh.)

To clarify: I just broke them up into stages for easier reading, I don't know if they're universally-recognised terms. It's probably more appropriate to say that something went wrong at certain points of development rather than saying that the person is in a particular stage.

Ah, okay.

Hey, this isn't a burning need to know the answer, but when you rock your lower jaw to one side and that lump rises up at the temple, what is it? It doesn't feel like muscle, but it also doesn't feel like bone, and looking at anatomy diagrams isn't giving me the answer.