Tag Archives: Starke is not a real doctor

Gut Wounds and Bleeding to Death

Hello! Thanks for running this (very helpful) blog! So, if a character was to loose a decent ammount of blood (enough to make them loose conciousness, etc, but not actually die.) what would the recovery process for that look like? How long would they be unconcious? How soon would they be able to stand/move? The character in quesion is very physically fit, and the blood loss was due to a wound in the side/abdomen area via a sword, if that is relavent. Thanks for answering!

Probably never, barring necromancy.

So, loss of consciousness from blood loss usually means you’ve lost over two liters of blood. That’s about 40% of the blood in your body. If you’re loosing blood fast enough to pass out, chances are, without immediate medical attention, you’re going to die.

Getting stabbed in the abdomen in a really bad wound. There’s a lot of organs in there that are simultaneously vital for keeping you alive and healthy, but also exceptionally adept at killing you when abused. Your kidneys and liver are basically large repositories of blood waiting to end your life from internal hemorrhaging. Your intestines are just waiting to put you into septic shock and kill you if they’re nicked by a blade. Your stomach is something you really don’t want to see ruptured.

Lower abdominal wounds aren’t just really dangerous, they’re actually pretty nasty and graphic. This is a lot of stuff you do not want to damage. And will require some pretty advanced surgery to survive and recover.

So, stepping away from that for a moment, if a character suffers a wound, and is bleeding severely enough for them to lose consciousness at a relatively rapid pace, it will kill them. As mentioned earlier, losing more than about 2 liters will cause you to lose consciousness, but fatal bloodloss ranges from 2.5L to 4L lost (depending on the individual.) At best, they lost consciousness half-way to dying, and they will bleed out in roughly the same amount of time.

There’s some potential situations, where the victim is able to seal off a wound in the field before passing out. For example, if they stabbed through the arm and had been losing blood, but had the presence of mind to cauterize the wound before losing consciousness, they might recover. (Though, this wouldn’t apply to an abdominal wound.)

Multiple (relatively) minor wounds might be able clot, saving their life, even if the cumulative bloodloss would have been fatal eventually. This is especially true if they lose consciousness some time after the injuries. However, this is a somewhat artificial situation, because the character would need to lose enough blood to go into hypovolemic shock, while also managing the rate of bloodloss carefully enough as to avoid killing them. It could happen, I’m almost positive that it has happened, but engineering that situation is tricky.

Beyond that, it’s worth remembering that hypovolemic shock is actually pretty debilitating long before you lose consciousness, slip into a coma and die.

(Keep in mind, these are modern medical terms and wouldn’t apply in a fantasy setting.) Hypovolemia is grouped into 4 stages.

Stage 1 is up to 750mL lost. The victim will appear pale, but otherwise they’re fin. They may feel terrible, and drained, but this is the stage where they’re still functional.

Stage 2 is 750-1500mL, at this point the victim will start to experience anxiety, and they will start to experience mild tachycardia, and their respiration will increase.

Stage 3 is from 1500mL to 2L, and at this point the victim will start suffering serious cognitive impairment, they’ll be confused, their heart rate will be roughly double what it should be, their respiration rate will be significantly increased.

With Stage 4, loss of consciousness, coma, death. Technically, you can be in stage 4 without losing consciousness. Though the mental state is not great. There’s also more severe tachycardia, their skin may appear mottled (with some patches appearing completely drained of blood), breathing will be very rapid and shallow. This is someone who is dying and you can see it.

If you are losing a lot of blood, and you lose consciousness, it’s over, you’re dead. As a result, your body does everything it can to delay that from happening. Even by Stage 2, you’re not going to be in fighting shape. You can’t just keep fighting through that much bloodloss.

When it comes to recovery, there is a trick. Your body can produce plasma pretty quickly. You can recover the loss of 2L of blood in 24 to 48 hours, sort of. The problem is that your body is only producing plasma to bring the volume back up. Actually replacing the lost blood will take a lot longer. Probably 4 to 8 weeks, depending on the individual.

I’m not 100% sure what the symptoms would be for someone having that much plasma in their circulatory system. It wouldn’t be life threatening, but would be unpleasant. I’m pretty sure fatigue, headaches, visual and auditory hallucinations are on the table, but I’d need to do a lot more digging into this specific situation to be completely certain. Regardless, symptoms would drop off pretty quickly over the weeks as their blood plasma levels evened out.

-Starke

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Hand Injuries That Could Prevent Using a Sword

Hi! I was wondering if you’d be able to tell me about some hand/arm injuries that could permanently prevent someone from wielding a sword? Sorry if this is a weird ask..

It’s not so much weird, as vague. There’s a lot of range on this. I mean, a severe CTE could prevent someone from effectively using a sword, though, obviously, that would come with some other, more significant, symptoms.

So, the most obvious answers are:

Loss of the hand or arm. If you don’t have an arm, you can’t pick up a sword with it. This one is kinda self explanatory. Worth remembering Götz von Berlichingen. He will come up, basically ever time we talk about lopping off a hand. A Bavarian mercenary, he lost his right hand to cannon fire in 1504, and had prosthetic replacements made, which he would continue to use while campaigning over the next 40 years.

While less dramatic, the loss of fingers can leave you without the ability to hold a sword. Also, I suspect, the loss of the thumb. I won’t rule out the possibility of custom modified blades specifically for individuals who’ve lost digits, but, generally safe to assume they can’t just pick up a sword.

Nerve damage could leave the hand or arm partially paralyzed, resulting in the inability to effectively wield a sword, without complete loss of the arm. These can originate from relatively minor injuries, if they damage the nerves. I had a friend who had lost sensation on a patch of their palm because of a (non-poisonous) snake bite. (The snake had damaged the nerve connection to that part of his hand.) Though, this didn’t affect his overall usage of the hand, you could easily end up with a penetrating wound like this either disabling some fingers, or the hand entirely.

Probably worth knowing, that some animal venoms can result in tissue atrophy, or necrosis (meaning, the meat literally rots off of the body.) It’s pretty horrifying, and, yeah, get the wrong spider bite on your hand without access to modern medical resources, and you could easily lose it.

Improperly healed broken bones in the hand could impair the manual dexterity enough to limit, or outright prevent the use of a sword. I’m a little fuzzier on exactly how this could happen, but because the bones in your hand are pretty delicate, it’s not a short list.

Somewhat obviously, this isn’t an exhaustive list of possibilities. I’m still thinking of other things that could potentially mess up the hand to the point where you wouldn’t be able to use a sword. Likely, the answer is as simple as it getting stomped on by a horse, or losing some fingers to someone else’s blade, but there are a lot of ways the human body can break.

-Starke

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Keeping Your Fighters Well Fed is Vital to Their Success

I have multiple fighter characters who are also poor and sometimes starving beggars. How would this less than optimal physical health affect what a fighter might need? My story is sort of fantasy but there isn’t a lot a magic at least when it’s about people.

Disastrously.

So, any extreme physical activity will require a pretty significant caloric intake. Meaning, if you’re fighting, you need to be well fed. There are countless aphorisms and clichés about the importance of logistics to military campaigns (such as, “an army moves on its stomach”) and there’s a truth here: It is vitally important that your fighters are well fed.

So, the big problems from chronic malnutrition for your characters are: an impaired immune system (meaning they’ll get sick more easily and have more difficulty fighting it off), generalized fatigue and weakness, cognitive impairment (difficulty thinking and focusing), and a slowed healing rate.

Slightly less severe, but they’ll also have increased difficulty maintaining their body temperature, meaning they’ll frequently feel cold. This has some real applications if you’re needing to wait overnight somewhere watching for someone.

If your character is underage, chronic malnutrition is catastrophic, as it will permanently impair their physical and mental development.

So, the short version is, your characters will be weaker, slower, more prone to injury and illness, less able to recover from injuries taken, and less able to focus on the fight in front of them.

You really cannot win a fight if you’re not getting enough to eat.

In a larger context, if you’re leading a group, and you can’t feed your fighters, your group will scatter. It’s one of those Maslow’s Hierarchy of Needs things, if you literally cannot keep your people alive, they have no reason to follow you. If you can keep them fed, but can’t keep them safe, they may stick around until that illusion is shattered, but then they’ll be looking for something better. If you can do both of those things, then you need to worry about keeping them happy, and need to worry about giving them a purpose.

One place where shoddy writers will manufacture drama is in these kinds of survival situations, but, because they didn’t consider Maslow’s Hierarchy, the whole thing will feel a bit, “off.” They’ll have characters who are facing a lethal threat, but they’ll be upset about accommodations, or engage in political infighting. Things that are, absolutely, not a concern when characters are being hunted, or facing starvation.

So, the short version, you need to feed your fighters. Following that, unless you’re setting up some kind of authoritarian cult, you need to feed your other members as well. After that, your fighters need to be able to protect the other members of the group (to some degree. And, there is a reasonable tension in their difficulty with that point.) If they can’t protect the group, then the group will hemorrhage members. If they can’t feed the non-combat members, they’ll leave, and if they can’t feed anyone, the group will splinter and the individuals will go looking for someplace where they can avoid starving to death.

-Starke

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Starke is not a Real Doctor for Elves

Hi! I’m writing a short story in a fantasy universe where a character (an elf, hard to kill by human standards) is chained to a wall and then lifted up incredibly high by the unhumanly tall antagonist and let go. The back of his head hits the wall, he’s (possibly?) knocked out for an undescribed period of time. Would this cause brain damage? Specifically, damage to the cerebellum? If so, how would that affect the characters?

Yes, probably.

So, with humans, getting knocked out from blunt force is some degree of brain damage. In a best case scenario, there’s little (or no) detectible impairment, but we are talking about someone suffering a concussion serious enough to nearly kill them. Even in that best case scenario, getting back up afterwards would be extremely difficult and painful. In a less ideal scenario, there would also be some long term damage.

The problem is, your character isn’t human, and even when we’re talking about something like elves, there’s a very real potential for some seriously weird physiology going on there.

Setting that aside, for a human, you’re looking at all the normal symptoms of a concussion. Headaches, nausea, slurred speech, hypersensitivity to light and sound, cognitive impairment, and memory issues. I’m not 100% certain if that’s damage specifically to the cerebellum (though it’s certainly possible) or if those are just the greatest hits for bouncing your brain off bone.

Not everyone will experience all symptoms, not all symptoms will have equal intensity across all cases. Every concussion is a new and unique trauma.

You may notice I didn’t include loss of consciousness in the list above. It’s one of the more severe symptoms. Getting knocked out, especially for more than a few seconds, is a very serious medical situation. As in, “you could die, or be left a vegetable.”

Now, returning to what I mentioned earlier, it’s entirely possible that the elves in your setting are physiologically extremely different from humans, (at least neurologically, if not across the board.) It’s entirely possible they cannot suffer concussions at all, in which case the experience of having their head bounced off paving stones may be unpleasant but not particularly dangerous. This may even be likely if your elves are supposed to be that resilient, as the head and brain, are particularly vulnerable to injury.

As for getting knocked unconscious? With humans, that is brain damage, every time. And concussions are cumulative, meaning your average protagonist who gets clubbed over the head on a weekly basis would be dead in short order.

-Starke

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How Adrenaline Affects the Perception of Pain

I hope this isn’t a silly question… Is it possible to be stabbed and not notice it immediately? It doesn’t matter if it’s in an extreme condition or not.

Yeah, it happens. Same thing with getting shot or other minor injuries. An adrenaline rush dulls your ability to feel pain, and it’s frighteningly easy for someone to suffer mortal injuries during a fight and not realize it.

This is why you see characters depicted checking themselves for wounds. This is sometimes played for laughs, but it is a practical behavior. If you’ve just escaped from someone attacking you with a knife, (or getting shot at), you need to know if you have an injury you’re not aware of.

This also happens with minor cuts or bruises. Those are less important, and you’re much less likely to notice them in the moment. (Actually, you won’t notice bruises in the moment, because it takes a few minutes for a bruise to fully form.) But you’re unlikely to identify the injury until after the adrenaline wears off.

I’ll do you one better, I remember the hit that caused the scar on my index finger. I wasn’t under an adrenaline rush, and I barely felt it. Initially, I thought the blade hadn’t connected, as it was just a white line and looked kind of like a welt. Then, after a few seconds, it started bleeding.

So, yes it is entirely possible to suffer a slash or stab from a knife and not realize the severity, or that it even happened. This is especially true if you’re in a life threatening situation, and are experiencing an adrenaline rush or intoxicated.

Technically you should feel the hit, but without an associated pain response, you could easily miss it.

-Starke

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A Friendly Little Stabbing

So we know that there’s no 100% non-fatal or “safe” place in/on the body to shoot someone. (That one scene in the first Divergent book where Tris shoots someone in the shoulder to get him to reveal information without killing him makes me cringe every time) What about stabbing? Where is the “least fatal” place to be stabbed, if there is any at all?

Very lightly.

Okay, so, deep penetration has a very high likelihood of hitting something you need to continue functioning. Again, getting stabbed in the torso is worse than the limbs, though this does depend on exactly what gets cut.

Your bones are slightly better at handling an object trying to impale you than stopping bullets, which isn’t saying much, but it can stop a light blade if you’re lucky.

Cuts to the limbs are less likely to be life threatening, and your arteries are somewhat better shielded against slicing and cutting trauma. That said, if someone drives a knife into your inner thigh, you’re (probably) already dead.

The rule of thumb I was introduced to is, “three inches,” if the strike goes deeper than that, it’s probably going to hit something vital. Also, it occurs to me, that does nicely cover most places where you’re not likely to suffer a vital hit. For example, you can get stabbed through the hand with minimal risk to your life (though, you are going to lose the use of that hand, at least, until it heals.)

That’s a larger problem you should remember. The muscles on your body are not (as a general rule) vital to your continued breathing, however, they are necessary to move and function. So, if you get a deep gash on your upper arm, it won’t kill you, but it will impair or weaken some direction of movement as those muscles are responsible for controlling your limb.

The real danger with stabbing is (usually) blood loss, and the further the injury is from your core, the lower the risk of bleeding out. Again, taking a hit to an artery will end you, and this can even happen on your wrists (though the bleedout will generally take longer, as the volume loss per second will be lower.) The nature of the cut matters, because in some cases it’s relatively easy to staunch the blood flow. As with gunshot wounds, the lethality of a given injury isn’t really about how “lethal,” it is, it’s more about how quickly you’ll lose blood.

There is an interesting caveat with getting stabbed or impaled: Do not remove the intruding object unless you absolutely have to. If someone gets stabbed do not pull the knife out. In some situations, the blade (or other object) will be preventing further blood loss, and pulling it out can be fatal. I’ve been told this is especially true of situations where someone’s been run through with rebar, to the point that it’s actually better to cut away the rebar if possible and bring it along, as the texture is exceptionally good at digging into the wound and limiting bleeding. (Obviously, cutting rebar for transport to a hospital is going to require construction or other lifesaving equipment, and not exactly a do-it-yourself solution.) The result of this caveat is, you can take a knife to the chest without dying, so long as the knife stays where it landed.

As with getting shot, there isn’t a great place to get stabbed, but it can be survivable if you can get medical attention before the blood loss is fatal.

-Starke

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Gunshots and Hearing Loss

How do constant sounds from firing guns affect hearing? Do soldiers use some kind of protection?

Yes.

The sound of a modern firearm discharging is loud enough to cause damage to the ear. This will result in hearing loss over time, it can also result in migraines and tinnitus. Hearing loss is the most common disability among US Military veterans. Basically, if you spend a lot of time around discharging firearms, without wearing ear protection, will suffer some degree of hearing loss.

Soldiers should be wearing hearing protection at all times, but, that doesn’t mean they always do. Same thing is true for people at a firing range. They should be wearing eyes and ear protection at all times, but you’ll see idiots who eschew them semi-frequently (at least, at poorly policed ranges. Some ranges will be a lot more careful about this for liability reasons.)

The US military issues dual use earplugs designed to filter out loud battlefield noises, which could cause hearing damage, while simultaneously not filtering lower volume sounds. I’m not sure how effective these are, as there was a major lawsuit back in 2015, regarding the earplugs produced by 3M.

Either way, if you’re using a modern firearm, you should be wearing ear protection of some kind. This isn’t as true historically. The actual problem isn’t the gun, it’s the propellent. Modern firearms use (variations of) “smokeless powder.” Smokeless powder dates back to the late 19th century, and had a lot of implications for firearms engineering. It burns more cleanly than black powder. This means there’s less fouling in the gun. (Fouling is residual unburned powder remaining behind in the firearm.) This means that firearms built to use smokeless powder cartridges can be far more mechanically complex. The downside is that smokeless powder gunshots are significantly louder than black powder ones. Which is why I’ve been stressing, “modern firearms.”

So, in answer to your questions: Yes.

-Starke

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On the Challenges of Hearing Impairment in Combat

How would being deaf or other hearing difficulties affect fighting? Could one good ear be worse off than completely deaf? I don’t think it matters with long range weapons, but could it?

The biggest problem is, simply, situational awareness. If you can’t hear, then you can’t hear. So, you have one less sense to track potential threats in your environment.

In a simple one-on-one situation, this isn’t likely to have major ramifications, but in a less controlled environment, with more potential enemies, it means your ranged senses are limited to what you can see.

There’s also a reflex implication. It takes the brain longer to parse visual data than auditory data. We’re talking about fractions of a second, but it is a factor.

In situations where sounds are the first sign that something’s happened you wouldn’t have that information. For example, if someone starts shooting and you’re not looking directly at them, you would need to parse what you’re seeing, and then realize what that meant. That’s a significant delay over someone in a similar mindset who could hear the initial gunshots.

Generally speaking, if you have one functioning ear, you still have a sense of hearing. The only thing you lose is the ability to effectively track direction.

There are situations where not being able to hear is a marginal advantage. Particularly with firearms. If your ears don’t work, you don’t need to worry (as much) about damaging them from loud noises. Modern gunpowder is loud enough to cause hearing damage, and that’s something that you don’t need to worry about if you can’t hear anything to begin with.

This extends to situations where someone with functional ears can end up with crippling headaches, and tinnitus for days after prolonged gun battles. Now, if you are deaf, you can still suffer from tinnitus, and in some ways it’s worse, because you cannot drown out the ringing with ambient sound.

Related to that, because firearms are so loud, communication in combat is primarily non-verbal. You can’t shout, or hear each other, over the gunfire. This has lead to an advanced system of hand gestures. So, you don’t need hearing to be able to function in a gun battle, and you have a marginal advantage in that you don’t need to bring hearing protection, and won’t suffer from its absence.

-Starke

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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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