Tag Archives: Starke is not a real doctor

Q&A: The One Armed Bodyguard’s Greatest Foe: Doors

I have a character who is a skilled warrior (guard for the royal family’s children) and was born without their left arm. They mostly fight unarmed, however, I don’t think that would be super effective against someone with a sword. Are there weapons that someone could use efficiently with one arm?

december-rains

“They mostly fight unarmed?” I think I see what you did there.

You’re correct that an unarmed fighter would be at a significant disadvantage when going up against someone armed with a sword, or anyone with an extra arm they can use to strike with while parrying an incoming blow.

The hard thing with questions like this stems from a misunderstanding about combat. Combat isn’t about being, “good enough,” it’s about leveraging any advantage over your foe.

A sword vastly increases one’s reach and lethality. As we’ve mentioned before, reach is an incredibly important part of combat, but is frequently overlooked in entertainment. If someone can kill you at a distance where you cannot respond, you have no path to victory.

You’ve heard the cliché of bringing a knife to a gunfight, and that’s because of range. The problem is, while it’s a less extreme example, bringing a fist to a swordfight will be just as suicidal.

So, what weapons can someone use effectively with one hand? Well the sword comes to mind immediately. Most swords are usable one handed, even the large two handers, such as the zweihander or claymore. The two-handers will be more awkward in a single hand, but they are usable.

Competitive fencing is no stranger to one armed duelists. Particularly with weapons like the rapier or foil, your off-hand is primarily used for balance, and a one-armed fighter, who can adjust to their lack of an arm, is not at any real disadvantage.

In fact, loss of the non-dominant arm in fencing is not enough to make someone eligible for the Paralympics. As far as Olympic and Paralympic rules are concerned, a one armed fencer is not considered disabled. There are even a few very successful examples, such as the elusive Al Snyder, who was the 1944 US National Foil Champion. From what I can understand, he lost his right arm to a shotgun blast as a child, and took up fencing in college (at Stanford) with an exceptional competitive record.

It’s been less than two months since we last mentioned Götz von Berlichingen, but if we’re on the topic of one armed soldiers, he is an important example.

If all of this sounds unusually positive, I do have an issue, and it’s a big one.

(guard for the royal family’s children)

I have absolutely no problem seeing someone like this as a swordmaster or master at arms. I could see someone like this training members of the royal family in the use of the sword. Possibly even see them as the commander of the palace guard. It would depend on personal history, but these are all (conditionally) plausible.

As a minor nitpick, I think it’s more plausible if they lost their arm in combat, rather than as a congenital defect, simply because that would smooth the line for how they got into their position. It makes a lot of sense for a member of the royal family to keep someone around who’s been their trusted personal guard for the last 30 years, and lost an arm defending against a failed coup a decade back, while moving them into a position where they’re still as valuable. It makes less sense for the master of the guard to look at a one armed kid who wants to sign up, and say, “yeah, we’ll take you.”

The problem is the job itself. It’s not that I don’t think the character can fight. It’s that I know they cannot open a door behind them while keeping their weapon trained on the assassin who just burst through the window.

That may sound petty, but it’s the tip of an iceberg. You have a character who cannot use their off hand to take any action while they have their weapon drawn. (Because the off-hand doesn’t exist.)

The example above is one of the more glaring issues: They cannot open a door or operate any machinery without putting away their weapon. In a situation where seconds matter, that could easily be fatal for the children. Relying on the children to keep their cool during a crisis is an incredible gamble.

Similarly, when faced with an opponent armed with a shield or parrying dagger, they are in extreme jeopardy. If their strike is blocked or deflected, they have no defense against a riposte. This is not a consideration in fencing, because, in a sport environment, competitors have standardized equipment, and rules designed to ensure a fair match. None of this is true when your character is in an actual battle (or fending off assassins.)

Now, if the question is, do I think a sufficiently hardened one-armed swordfighter could safely dispatch a four limbed assailant? Yeah. Absolutely. However, assigning them as the personal bodyguard (no matter how good they are) would be irresponsible for several reasons.

First, that door example means they can’t evacuate the children from a dangerous situation without dropping their guard. This is more universal than the specifics would suggest.

Similarly, they can’t carry an injured child to safety and open doors on the way. Realistically, that’s a much more pressing concern. It’s unlikely that the royal children are presented with attempts on their life on a regular basis. However, the risk that one of the kids is injured by… anything, and incapacitated is a real danger.

Those kids are not just kids. In a, hereditary monarchy, they are simultaneously, and incredibly valuable diplomatic resource, and the continuity of government. Only giving them a single guard collectively, no matter how many limbs they have, is extremely concerning.

Again, I could see a one-armed veteran guard acting as the head of their security detail, but that would be talking about your character having a squad of guards at their command, not simply being, “their personal guard.” Particularly, if your one-armed character is (almost) always accompanied by a subordinate.

So, what could the use? A sword. But, that’s not the biggest issue here.

-Starke

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Q&A: Symptoms and Combat Implications of Hemophilia

I’m writing a character that has to engage in hand-to-hand combat but she has haemophilia. So, fighting face to face would be the last thing she’d want to do. Is there any fighting styles/techniques that she would learn that would decrease her chance of getting a wound?

For those unfamiliar, Hemophilia is a genetic mutation that impairs clotting. Specifically, the mutation prevents the production of specific proteins responsible for coagulation of blood. This usually gets presented as the patient having difficulty managing injuries suffered, and that part is true; a hemophilic needs to be careful of any injury (including bruising) as it can potentially become life threatening.) However, it goes beyond that.

The reduced clotting factors do mean that injuries, particularly severe ones, will result in difficult to control bleeding. This is also an issue with post-surgery. Spontaneous bleeding can also result in joint stiffness or pain (from internal hemorrhaging around the joints), bleeding into the soft tissue, (which can manifest as bruising or hematomas), chronic, and persistent nosebleeds. A bleed, including a spontaneous one, in a vital organ can kill you.

The defect that produces hemophilia is carried on the X chromosome. This means that, while women can be hemophilic it’s quite rare. Their father would need to be hemophilic, and their mother would either need to hemophilic or a carrier (meaning one of their chromosomes had the mutation, and as a result were not symptomatic.) If their mother was non-symptomatic, there’d still only be 50% chance of their daughters being hemophilic.

Because it’s extremely unlikely to occur in girls, it’s rarely tested for unless symptoms have been identified. (With boys, it’s common to test for hemophilia at birth if there’s any family history of it.) In particular, two major symptoms for women that are tracked are extremely heavy menstrual bleeding, and menorrhagia (where mensuration lasts for more than 7 days.) As a result, it’s uncommon for (mild cases of) hemophilia to be diagnosed in girls before puberty.

Treatment is usually handled by administering concentrated clotting factor proteins to the patient. Keep in mind, this is, “treatment,” not a cure. With sufficient technology, it may be possible to use an implant to administer clotting factor proteins on a regular basis. Of course, it might also be possible to use a retrovirus (such as crisper) to modify and remove the genetic defect. If you’re in a less technologically advanced setting (alternately a disaster scenario that extends over multiple months, or a post-apocalyptic setting), prepackaged protein infusions probably aren’t an option.

When it comes to violence, hemophiliacs really can’t afford to get into a fight. Under normal circumstances, you’re going to end up with minor bruising from hand to hand combat. Add in hemophilia, and that bruising is going to be significantly more dangerous. You’re looking at an internal hemorrhaging risk that someone without the mutation wouldn’t need to worry about. At the upper end of the spectrum, this includes a real risk of seizure from blows to the head, even with a relatively mild cases of hemophilia. Relatively minor trauma can be life threatening for a hemophiliac.

Here’s a problem, martial arts training will include a lot of, “relatively minor trauma.” You’re going to end up with bruises on your arms, on your thighs, on your hands. You’re going to end up with bruises in places you can explain, and bruises in places you can’t. You’re going to get banged up. That’s normal. That’s not accidents. That’s not sparring. That comes from the training itself. You will do it to yourself, and not even be aware of it at the time. Accidents, when they happen, are much worse, and you can easily see broken bones or soft tissue injuries. For a hemophiliac, the normal wear and tear of marital arts training comes with a very real risk of death. This doesn’t mean a hemophiliac can’t train in martial arts (many do), but, it does preclude combat training (and full contact training of any kind.) Hemophilia even precludes joint manipulation, both applying and receiving. It’s stereotyped as the “gentle” form of martial arts, but the strain it puts on your body is actively hazardous to someone with hemophilia. It’s the kind of physical disability a dojo needs to know about, and needs to plan around.

To put this in context, I’m currently looking at a case where a middle aged man fell 3 meters (roughly 10 feet), and was hospitalized from hemorrhagic shock. Meaning, a relatively mild accident, which you or I would probably just complain about, but go on with our day, nearly killed him from blood loss, due to his body’s inability to clot. He was in the hospital for 10 days and had to undergo surgery to survive.

So, while someone with hemophilia can live a full life, mild trauma is life threatening to them. Engaging in violence will kill them. Barring significant medical treatment, they need to live carefully. Additionally, hemophilia among women is real, but is also quite rare, because the mutation needs to occur on both of their X chromosomes.

I’m inclined to say, “no,” there really isn’t this character could be getting into fights (and surviving), unless their clotting factors have been brought up to line with non-hemophiliac blood levels.

-Starke

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Q&A: Hypothermia and Alcohol Intoxication

Any tips on writing dialogue featuring a character suffering/recovering from hypothermia? At a glance it seems like hypothermia makes you act kind of like you’re drunk, is that accurate?

transquad

I’m not completely sure. I’ve never seen severe hypothermia first hand, so I’m going off diagnosis guides and making a guess. That said, I have seen a few warnings about potentially misdiagnosing hypothermia as alcohol intoxication, which makes me suspect these are very similar.

This is a little more complex than that, because, from my limited research, alcohol intoxication seems to exacerbate hypothermia. Your body temperature crashes faster, and you stay intoxicated for longer. This is because hypoglycemia (low blood sugar) interacts viciously with hypothermia, and excessive drinking can result in (temporary) hypoglycemia.

If you’re wondering, “if it’s that dangerous, why would anyone drink in the cold?” The answer is fairly simple, alcohol makes you feel warm. This is why there are traditions about consuming hard liquor to endure or recover from the cold. The biological reality is that warmth is an illusion, but the experience led people to believe that alcohol helped dealing with the cold.

To your question about dialog; Hypothermia’s slurred speech and impaired cognitive function could look a lot like alcohol intoxication. However, when it comes to, “acting drunk,” not so much. There’s a number of specific physical symptoms beyond the slurred speech and confusion associated with hypothermia. Hypothermia will result in drowsiness, so no matter what kind of a drunk you normally are, hypothermia will look like a sleepy drunk. Beyond that, there’s shallow breathing, a weak pulse, and of course shivering.

So, hypothermia doesn’t look like alcohol intoxication, however, the slurred speech, mumbling, impaired coordination and cognitive function do. It’s close enough that hypothermia can be mistaken for alcohol intoxication in a cold environment by someone without medical training, but not so close as to say that it’s just drunk in the snow.

-Starke

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Q&A: Adrenaline

hello! so, i’ve been reading your posts for some time and i was wondering about how the adrenaline really works in a fight. i read an article saying that adrenaline, specially when “normal” people fight (not pro fighters), works like an advice to run for your life. not like something that inspires you to fight. but, i can’t confirm this information, because i can’t find another person talking about it. so, may u write something about how adrenaline works in real situations? thank u so much!

hwfflepff

The short answer is that adrenaline is a hormone. When threatened, your adrenal gland secretes epinephrine (adrenaline.) Like most hormones, it affects a many organs uniquely.

I’m going to be a little reductive here, the major effect is that adrenaline increases the conversion of sugar into energy, and reduces the production of insulin, meaning you’ll keep that energy longer. It also increases your respiration rate, hyper-oxygenating your blood, and your heart rate, getting that hyper-oxygenated blood to your brain.

Adrenaline increases your pain tolerance significantly. Though, I’m not sure what the mode of action is for this effect. It also increases your apparent strength, though this is a little misleading. Humans are, in general, much stronger than most people realize. However, we moderate to prevent self-injury. Because adrenaline reduces pain, in combination with the other changes, this results in a significant strength increase. The reason you wouldn’t normally do this is that you’ll pull, wrench, and sprain muscles. This is still true during an adrenaline rush. You just don’t feel the pain, but it doesn’t make you more resistant to damage.

The entire result is vaguely analogous to, “overclocking,” your body. It will function more effectively for the duration, but the process is very stressful for your body overall. It’s a biological function that prioritizes immediate survival over general health.

After the immediate threat passes, the individual will be left with a lot of nervous energy from the rush. They’ll be jittery. This leads to a comment I’ve made before; I deeply dislike adrenaline rushes. It’s useful in the moment, but in my experience it always outlasts the provoking incident. Though, I’m fully aware my experiences are not universal. While it’s not going to be true for everyone, figure your adrenaline will crash roughly an hour after the initial rush. (The exception would be if you’re under constant stress. In those cases, the heightened adrenaline levels can persist for the duration.)

When your adrenaline crashes, you’re going to feel exhausted (and potentially nauseous.) This is the normal consequences of what you just put your body through. You will become aware of injuries you sustained during the rush, including some of the muscles you overtaxed.

If heightened adrenaline levels are maintained for long periods of time, this can have disastrous effects on the heart. You really cannot safely sustain the elevated heart rate, and eventually it will fail. Because adrenaline rushes are triggered by stress, they can be caused in situations where they’re neither useful nor helpful. This can include constant adrenaline production because of stress. PTSD is one situation where adrenaline rushes can be triggered by an inappropriate stimuli. This can pose a real health threat. This can kill you.

Adrenaline will not grant you insights into fighting. The fight or flight response is a biological response to danger. It’s important to understand, “fight or flight,” is a single response. It’s not like you have a, “fight,” response, and, a separate “flight,” response, it is a single biological response for either course of action.

Adrenaline is not “blind instinct.” While it will affect your brain, it’s not going to shut you down into a feral fugue. You’re still (theoretically), a rational, sapient being. Adrenaline doesn’t change that. You will be thinking faster, but not smarter, so if you’re prone to making dumb decisions you can now expedite that process.

In two words, “not fun.” Adrenaline is a useful survival tool. It can be the difference of living and dying, however, it is just a chemical your body keeps around in case things go horribly wrong.

-Starke

Q&A: This Will not be on the Test

I was wondering what are the standard teachings that comes with fighting? I mean, what else do you learn? You seem knowledgeable about medical stuff. Is it your merit or do people get taught about those along with their education etc.

There isn’t a single, “standard,” here. Martial arts classes will teach you whatever the instructor feels is relevant to your training. If they think you need anatomical knowledge, they’ll teach you that. If they think you’ll need to learn about human behavior and psychology, they’ll cover that instead.

So, with that said, I didn’t learn this in martial arts. My medical training, such as it is, comes from two sources.

First, I’m an Eagle Scout, including some limited medical training. I don’t remember how many medically related badges I have. At least two, probably more.

The second source is more informal. I was raised by a clinical pharmacologist, and a Methodist Minister who decided he wanted to become an EMT after a midlife crisis. While we’re not close, I also have a brother who’s an MD. The short version is, I grew up with an unusual amount of medical information getting thrown around, and picked up some more along the way..

My exposure to medical ethics came from psychology classes I took in college. It’s the only field where I maintained a perfect 4.0.

So, as I say in the tags on every medical post, I’m not a doctor. I can render first aid and that’s close to the end what I’m willing to do to another person. However, I have enough knowledge that I can offer advice from a writing perspective. Also, because of the informal background, I rarely have issues understanding online resources.

My formal education is, I have an associates in Computer Programming, and a Bachelors in Political Science, along the way I ended up 3 or 6 credits short of a minor in Psychology. Yes, that’s a weird educational path, and no it’s not a medical background.

Scouts included some medical training. Now, anyone who sticks with scouts will get some basic first aid training, however I also went back for merit badges on the subject, so my medical training was more extensive.

If anyone’s wondering, “how could you have forgotten which badges you earned?” I have over 40, I could not give you a list from memory if you put a gun to my head. I can’t even remember the names for all of them looking at my sash.

One of my self defense classes, the one in the late 90s, was explicitly from the Boy Scouts. The Scout Master was a Captain in the Air Force, he grabbed a Sheriff’s Deputy he knew and put the entire Troop through a couple weeks of training. Ironically, this was the least responsible round of training, as it prioritized the hand to hand component rather than focusing on situational awareness, threat assessment, creating an opening and extracting.

If you want to learn medicine, go to school for it. There’s certainly a need for medical professionals in the world. Just, be aware that it’s a very unglamorous profession.

If you want to learn martial arts, take a course. You can do both, unless you’re in your residency.

In general, a well run class (of any kind) will include the information you need to understand the material presented. (Or, in academia, will have published prerequisites.) There are definitely martial arts classes out there where you’ll learn a bit of A&P along the way. I probably learned some anatomy from martial arts and simply didn’t realize it. However, you’re not going to get medical training from enrolling in a martial arts class.

-Starke

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Q&A: Shot in the Leg

So I read your post on gunshot wounds to the leg and it was very helpful, but what I’m looking for is a little more specific. My character gets shot in the leg, clean, nothing major hit. The wound is bandaged. But immediately after she gets shot, she passes out and isnt aware of anything. Is that believable? If the wound was bandaged right away, would she survive being carried for an hour before even reaching the hospital?

So, what caused her to pass out?

There’s nothing wrong with being able to survive for hours after taking a bullet if it didn’t hit anything vital. Some gunshot wounds can take a long time to kill you. Bandaging it is a good idea, because it will slow the blood loss.

Blood loss can result in losing consciousness. You lose a lot of blood, go into hypovolemic shock, lose consciousness, and bleed to death. If a patient loses consciousness shortly after suffering a gunshot wound, that tells you to look for serious blood loss. You may want to double check and make sure you didn’t miss any internal hemorrhaging.

You know will not cause you to pass out? The pain from getting shot. I feel like I’ve written this recently, but pain does not make you lose consciousness. Pain will keep you awake. While I’m a little less confident of this, I’m pretty sure getting shot will keep you awake. Even if the pain doesn’t, the adrenaline will.

If someone gets shot and passes out, they’re losing blood fast. You lose consciousness when you’re down ~20% of the blood in your body. You die when you lose between 30% and 40%. Napkin math says, if someone gets shot, and it takes 30 minutes for them pass out from blood loss, you’ve got a bit less than 15 to 30 minutes before they’re dead.

So, you have a character who gets shot. Their leg gets bandaged, but they lose consciousness within five minutes of the wound, they’re not going to survive for an hour without medical attention. Even if it takes two hours for them to lose consciousness, taking another hour to get them to a hospital would be an extremely risky decision.

Now, if they’re semi-conscious for most of the ride. Say, the first 50 minutes, and lose consciousness about 10 minutes out, it’s going to be touch and go, they’ve still lost a lot of blood, but that is survivable. If they pass out ten minutes earlier, it’s distinctly possible they’ll be dead on arrival.

If she’s being carried by hand, that carries extra risks because it could aggravate the wound and accelerate blood loss. Especially if they’re carrying her with the gunshot wound at a lower elevation than the heart. The ideal situation would be to lay her out on a vehicle’s bench or a stretcher, with the injured leg elevated above the heart. If you’re bleeding to death, don’t let gravity help finish the job, make your heart work to kill you. It will buy you time.

Also, hand carrying another human being for that long will be exhausting. It’s not impossible, but unless someone’s in excellent physical condition, they might not be able to carry her the distance, and shuffling her between carriers runs the risk of aggravating her wound, making things worse. This is less of an issue if they’ve got her on a stretcher or some other kind of stable platform.

Now, it’s possible she lost consciousness due to some other factor, but I can’t think of any off-hand, that would improve her odds for her survival.

If she lost consciousness shortly after getting shot in the leg, it’s a very bad sign. She’s probably losing blood much faster than anyone realized and would be dead in minutes. My suspicion would be an arterial bleed, which can be managed to a degree by keeping pressure on the artery to reduce blood loss. However, we’re talking about a character having to shove their finger into her wound to stop the bleeding (which requires some fairly specific anatomical knowledge.) Given how fast she lost consciousness, I’m pessimistic about it buying more than a few minutes without serious medical attention.

So, is it believable? No. It’s entirely believable she’d remain conscious, going into shock. It’s entirely believable she’d lose consciousness shortly after the injury, and die a few minutes later. Unfortunately, it’s one or the other.

If she’s bleeding out, her initial symptoms would include a headache, vertigo, nausea, and increased perspiration. These aren’t particularly worrying. She’s loosing blood, but she’ll probably live. However, over time, she’d start manifesting more serious symptoms. These include losing body temperature (and feeling cold), starting to suffer from impaired cognitive function, particularly confusion. Her skin would become cold and clammy, and would get paler as blood pressure dropped. Her pulse would get faster and weaker, also as her pressure dropped. It would become harder for her to remain conscious. Eventually, she would lose consciousness. The faster these symptoms manifest, particularly the more severe ones, the more dire the situation. If she’s going straight to passing out, and help is an hour away, she’s already dead.

I’m sorry, but if she drops after the firefight, you just killed your character.

-Starke

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Q&A: Dextrocardia

I’m not sure if you could help as this may be more medical but someone in a fight gets stabbed in the heart with the weapon left in the body and left for dead. Thing is, that’s not the heart because the victim has dextrocardia, in other words the heart is on the other side of the body. Can the victim survive this? Or would the attacker know they missed the heart. Or do most attackers want to miss the heart because they don’t want arterial spray all over?

That’s not how dextrocardia works. That’s not where your heart is.

Your heart is in the center of your chest, between, and behind, your lungs. The organ is asymmetrical, and the left side is responsible for pumping blood, meaning it is larger on that side. However, if you’re trying to stab someone in the heart, that’s going to be center mass. Dextrocardia or no, you’re going to hit their heart.

If, for some reason, you decided to skewer their pericardium, and could find that in battle, but they had dextrocardia, you’d still collapse their lung. It’s not like, “oh, yeah, that’s not where I keep my heart, I’m fine.” You would still seriously mess them up.

Incidentally, impaired cilia functionality is sometimes associated with dextrocardia. The lung’s cilia are “hair-like” tissues that assist with respiration, and help protect the lungs from infection. This means that the sufferer may experience reduced resistance to airborne bacterial and viral infection, and they may have difficulty getting sufficient oxygen. These have serious developmental implications.

Something I’m not entirely clear on is whether dextrocardia is merely associated with heterotaxy, or if it is a form of heterotaxy.

Heterotaxy is a catch all of genetic mutations where the subject’s internal organs either aren’t where they’re supposed to be, or are oriented differently from normal. This can be benign in rare cases, but those internal organs don’t, usually, function properly. Additionally, some organs can appear as multiple smaller variants (which don’t function properly), or an organ can be outright missing (with severe consequences.)

In the case of dextrocardia, a common form of heterotaxy is a missing spleen. You need that for your immune system, and it’s absence is a pretty big deal. This will often require the subject to supplement their immune system with antibiotics.

Additionally, dextrocardia is frequently associated with other heart defects. It makes sense that the heart might not be in working order, but this can get wild, including the ventricles being reversed, a perforated intraventricular septum (this is the tissue that separates the ventricles), failure of the heart’s walls to develop properly (or at all), the complete absence of a ventricle, (meaning the subject has a single ventricle heart), or having both the pulmonary artery and aorta connected to the right ventricle, with the left ventricle being basically unused.) All of these can result in poor circulation (at least), and saying, “what if they get stabbed there,” comes after a host of other symptoms.

Worse, with already poor circulation, a collapsed lung is significantly more dangerous, before we remember they’re probably immunocompromised. Yeah, that would still kill them. If both ports are on the right ventricle, this also means they’ll have abnormally high blood pressure in their lungs. That place they’re now bleeding from.

There is one, slightly less dire diagnosis, though it’s not dextrocardia. Situs inversus is a rare condition where all of the subject’s internal organs are “mirrored” from normal. The heart leans to the right, the right lung is smaller, the liver is left(ish), the spleen is on the right (and functional.) This is usually benign. It occurs in ~1:10,000 people, and can be the result of a recessive genetic mutation, or it can be a non-genetic result of an embryo splitting during gestation creating “mirror twins.” One of the twins may have reversed internal organs. Worth noting, most mirror twins do not exhibit situs inversus, it’s still a rare condition there. (Most mirror twins will have normal internal organ configurations.) Because it’s benign, it’s rarely diagnosed directly, and usually comes up when the subject is seeking medical attention for something else.

Basically medical trivia, but someone with situs inversus cannot have dextrocardia (as a disorder), and instead would have levocardia. This because the name, “dextrocardia,” includes the direction the heart is leaning. Situs inversus with levocardia is exceptionally rare. Though there are a few documented cases.

So, can it save your character? Even with situs inversus, your heart is in basically the same place. Getting stabbed on the “wrong” side would still collapse your larger lung, and either hit your heart (if they’re close to center mass), or (if they were a little low) your liver. So, no, it would never be, “oh I left my internal organs in my other chest,” it’d still be a lethal, or near lethal, chest wound.

-Starke

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Q&A: Asphyxiation

i’m writing a story and in one scene, a character is being suffocated. i don’t really know how to write about it but i want to be realistic! would the body twitch or just go limp? would they go into a coma or die? sorry if this is too weird!!

If we’re skipping straight to asphyxiation, without any obvious cause, you’re looking at hypoxia. The victim may become tired, disoriented, or confused, and then pass out, slip into a coma and die.

However, if there’s a perceptible cause, such as someone strangling them, that’s going to provoke a violent response. With a major caveat, choking someone is not as easy as it looks. The import detail is that there are two kinds of chokes. Both rely on cutting off oxygen to the victim’s brain. You can do that either by preventing respiration, or by directly obstructing the flow of blood to the brain. The latter is far faster and more effective, but it’s not what you’d usually call “asphyxiation.”

Choking someone by preventing respiration it time consuming. We’re talking about having to continue to choke them, uninterrupted, for over a minute, while they fight back, and for several more minutes after they lose consciousness, “to make sure.” They will start to fade, and fighting back will hasten the process some, but in combat terms it’s still a small eternity. Just because they’ve gone limp doesn’t mean they’re going to die. Your body is remarkably skilled at breathing, especially when you don’t think about it, meaning there’s a real risk that they’ll begin breathing again after you stop choking them, conscious or not.

As for your other suggestion, they’re probably not going to be twitching. There’s a lot of things that can cause twitching, including messing with their nervous system directly, but the only thing I can think of associated with choking is in erotic asphyxiation. If that’s your thing, have fun, but I don’t think that’s what you were asking about. That’s also a byproduct, not a symptom. Maybe some kind of nerve agent could produce that result while also killing the victim, but I’m unsure.

Also, I usually reserve this for the tags, but I’ll remind you, I’m not a medical professional. I got my my First Aid and Medicine badges over twenty years ago, so this is outside my area of expertise. With that warning in place: You might also see twitching leading to asphyxia if the victim suffered a stroke or seizure. For example, a muscular spasm could close or collapse the trachea. However in that case, the spasm would be the cause of the asphyxia, not a symptom of it.

If it’s just something obstructing the airway that’s going to provoke the victim’s gag reflex, or get them coughing. This can also occur with some gases that will also interfere with breathing. The victim will respond, trying to clear the airway however they can. How well they can offset panic, and think their way through the situation will determine how well they respond. I’m aware a few anecdotal examples where people performed impromptu Heimlich Maneuvers on themselves using furniture, or other convenient objects.

Speaking from my personal, and somewhat distorted, experiences: Someone going for your throat is fucking scary. I’ve never reacted well to someone going there in a fight. You want to see a human being go into a frenzy? Go for their throat. You’re going to get hurt.

So, some unsorted technical information to work with.

Choking with two hands is, ironically, harder than with a single one. Your hands will get in each other’s way. A single handed choke has the disadvantage of being dependent one point of failure, but it is easier.

People do not react well to strikes that go towards the neck or face, (this is isn’t just me.) Or, perhaps, I should say, “they react too well.” Going for choke at arm’s length will give them a lot of time to respond. You’re getting very close to the center of their vision, so they will have an easier time tracking, and reacting to, this movement.

For someone with training, lifting their opponent off the ground with a single handed Darth Vader style choke is significantly easier than it looks, if their foe is against a wall. Downside is the victim will have all their limbs free. I guess if you’re a Dark Lord of the Sith it doesn’t really matter, but this kind of a move is better suited for theatrics and intimidation, not combat. It looks cool, and I wouldn’t be surprised to learn David Prowse could actually dead lift someone with one hand. Buit, you don’t want to do this.

For those times when you need to fake a death with a willing partner, it’s remarkably easy to “fake” a choke in front of witnesses. Just make sure you’re not actually applying too much pressure, play the role, and make sure no one gets a chance to examine the, “corpse.” The major risk here is if you’re trying to fool someone who knows what to look for.

“Safely” choking someone out usually involves coming from behind and wrapping your arm around their neck. Depending on how you do this it could either be simple asphyxiation or a blood choke. One benefit is that you can do this with something in your main hand. Your off hand can be used to fend off their attempts to retaliate.

Preemptively defending against this is actually really simple: Tilt your head forward until your chin is flush with your chest. Any attempt to choke you from behind will now require getting through your jaw. This will defend against both arm bar, and triangle chokes. It even offers some protection against being garroted, and chokes from the front. The key is, it has to be done before the choke gets under the chin, after that it’s too late.

I hope this helps, and please don’t try any of this stuff at home.

-Starke

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Q&A: Anemia

i’ve looked around and haven’t really found much on the topic, so i was hoping you guys would have a better idea. i have a fighter character who has anemia (as well as chronic pain). they definitely aren’t zipping around, but I’d be curious to what specific limitations these would give for someone who uses hand to hand and blades? thank you either way for your time!

Chronic pain is a problem, but anemia is a showstopper. The pop culture frame of reference is that anemia impairs or prevents clotting. If that was the extent of the condition, it would be serious enough to make combat exceptionally dangerous. If you can, literally, bleed to death from minor bruises, that’s going to make hand to hand exceptionally dangerous. However, that’s not what anemia is, and the reality is so much worse.

Anemia itself is a general condition where you lack sufficient red blood cells. The inability to clot is related to this, because the blood isn’t thick enough, however, this is only one of the symptoms, and while it can be life threatening, it’s not the biggest problem for a fighter.

Common symptoms for anemia include weakness, fatigue, and dizziness (among other things.) The simple version is that the body uses red blood cells to transport oxygen through to where it’s needed. In an anemic, there simply isn’t enough blood to transport enough oxygen. I can’t find concrete confirmation, but based on the cause, I’m almost certain that strenuous physical activity will aggravate the symptoms. This means an anemic fighter will exhaust very quickly, and is at particular risk for tachycardia (in addition to injury.)

Worth noting that anemia doesn’t, necessarily, prevent exercise, and in some cases it’s probably still a good idea, but the patient needs to be very mindful of their condition.

Also, not all forms of anemia are as dire as I’m making it out to be. I probably experienced mild anemia as a result of my excessive use of aspirin when I was younger. Seeing the symptom list now, I can say some of that was there, but at the time, it wasn’t severe enough for me to realize anything was wrong. The tipping point was when I was looking at watery blood from a nose bleed, and attributed that to aspirin being an anti-coagulant.

Additionally, anemia can be caused by a number non-self-sustaining causes. Aspirin is one (I suspect, the chronic use of any anti-coagulant will have similar results), heavy blood loss, and iron deficiency are also possible. In the case of blood loss, this is something your body will recover from with time. With iron deficiency, your body simply doesn’t have the materials it needs to make red blood cells, but if you adjust your diet, or take supplements you can manage this.

There are other causes, For example: I’ve been ignoring sickle cell anemia. In this case the blood cells exist, but they’re deformed, and can’t interact with the body properly. The resulting symptoms are similar, though the cause is distinct. I probably should point out that “pain crises” are a symptom of sickle cell anemia, if that’s the specific form of anemia you’re talking about, there’s a lot of literature on the subject, and some of the details vary significantly.

So, if your character has any condition which impairs the production of red blood cells, they may have very mild symptoms. They’re anemic, but might not even realize it, until they start losing blood. The problem comes in when their body can’t replenish lost blood fast enough. Initially their clotting factor may be close to normal. They won’t be impaired in combat. However, their injuries will stack up and over time their ability to recover, and even their ability to heal from prior wounds will go off a cliff.

Thing is, that can happen to anyone. An anemic condition will further aggravate, or jump start it, but if you’re losing a lot of blood, that will have knock on effects until you can fully heal. Again, serious blood loss will result in a form of anemia. It’s not a chronic condition, but your body simply doesn’t have enough blood, and it’s working to get back to where it should be.

If your melee fighter is anemic, it’s going to be a downward spiral. This is a condition where your body really cannot take a lot of abuse, and hand-to-hand combat places a harsh toll on your body. It’s even worse with blades, because you will bleed. That’s blood that you cannot afford to lose, and you won’t be able to stop bleeding.

-Starke

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Q&A: Stabbed in the Neck

What are the chances of survival if you get stabbed in the neck? For instance, by a six-inch knife? Where is the worst spot to take a wound like that, and where does it offer the highest chance of survival?

candelantern

The chances of survival are not great.

So, normally, the rule of thumb is: Three inches of penetration anywhere on the body is enough to kill. The thought process is that, if you’re going that deep, you’re going to hit something that’s either necessary, or that will cause the victim to bleed to death. When we’re talking about the neck, everything is a lot closer to the surface.

You need your spinal column. That’s pretty well armored, but it’s still vulnerable. Hit it with enough force, and you can knock the third or fourth vertebra out of position, severing the spinal chord, and killing them on the spot. Run a blade horizontally between those two, and you should be able to do the same with slightly more finesse (for whatever that’s worth.)

You need your arteries. That’s the carotid which is mirrored on each side. Sever either, and your life will be over in minutes.

There’s the trachea and larynx. You need those to breathe. They’re protected by a layer of cartilage, but that’s it. If it gets carved up, you’ll asphyxiate. This is survivable with immediate medical attention. But, this is well beyond normal first aid training. You someone with actual medical training on site.

There’s the upper esophagus which is important, though not immediately life threatening, but that’s shielded between the trachea and vertebrae.

There’s no place to get stabbed in the neck that isn’t immediately life threatening, everything’s either muscle or vitally important to your survival. Six inches of penetration will go all the way through, probably damaging multiple vitals.

Stabbing someone in the neck is a fantastic way to kill them. You’re almost guaranteed to hit something that will quickly end their life.

The most survivable neck injuries would be superficial slashes that don’t actually get deep enough to damage anything important.

Damage to the trachea is survivable if they can get immediate medical attention. But, again, you need a paramedic or doctor right there. This isn’t a case where, “I passed my first aid cert,” will cut it.

The worst, is a toss up. Anything that severs the carotid will kill them. Someone who knows what they’re doing could execute this pretty efficiently. They just need to drive a blade through the artery and open it up.

Running a blade into the spinal chord will also get the job done. That requires more precision, but this isn’t better. And if they’re striking from behind, aiming for the base of the skull is going to be easier and more reliable.

These are both really lethal outcomes, but realistically, if you’re running a six inch blade through someone’s neck, they’re dead.

-Starke

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