cardiac system

anonymous asked:

Your blog rocks! Thanks so much for helping us all out! Okay so I have a character and I need her to collapse/pass out after running, probably because she can't breathe properly (but she doesn't have asthma) and Im struggling with coming up with a reasonable scenario/injury/condition. Would being in a car accident harm the lungs in a way that would inhibit breathing? Would that cause fluid accumulation or something like that? How noticeable would an injury like that be before running/exercise?

Hey there nonny. There are a lot of reasons someone could collapse after a run. 

Running is a big strain on the cardiac, circulatory, and respiratory systems. There are significant strains on each, but mostly on the heart and the lungs. 

I think the avenue you want to go down really depends on what you want the overall effects to be on your character. If you want her to simply pass out just this once, there’s something I call the Syncope Trifecta: it’s the second or third day of her period, she didn’t get enough sleep, and she forgot to eat breakfast. I cannot tell you the number of young, healthy women I’ve met who faint after this constellation of events! 

If you want it to be related to an injury, she’ll need some form of injury to her chest, which is a fairly noticeable event. Maybe she was in a car crash she thought was minor, but she’s had a small bit of air slowly building up in her pleura (the lining of the lungs) for a few days and it’s just now starting to give her problems. It’s unusual but it’s possible. 

Alternatively, consider a heart defect. A good friend of mine is in her very early thirties and is going in for open heart surgery next week to repair a defective valve, which put strain on her pulmonary vasculature. She used to run five miles a day just six months ago; now she can barely cross the room without getting winded. So this could be how your character discovers she’s got a heart defect. 

Also… have you considered your character is simply pushing herself too hard? It’s not inconceivable for someone to faint after running too hard and ignoring the warning signs (feeling too hot, getting dizzy, feeling nauseous, seeing stars). 

Oh, one other thing: cancer. Cancer can cause fluid to build up in the lining around the lungs (a pleural effusion) and that can decrease your character’s aerobic capacity pretty harshly. 

I hope these have given you some inspiration! Best of luck. 

xoxo, Aunt Scripty


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chosen--undead-deactivated20170  asked:

i keep seeing sad headcannons about hancock turning feral one day but can that really happen? i dont think ive encountered a single ghoul who turns feral, i thought it was something that happened while they were turning from human to ghoul, like best case scenario they keep their brain intact, worst case it rots away with their skin. but does it say anywhere that its possible for a standard ghoul to turn feral eventually?

Honestly, this is such a difficult question. There are so many contradictions regarding ghoul physiology, and different parts of the fandom tend to believe different things. This whole thing started as a wholly speculative response, but I’ve done some research, so, anyone who wants to find a bit more about

Ghoul physiology

is welcome to read this.

The only ghoul that I know of that has gone feral is Ben from Nuka Break but this can hardly be seen as canon. In the end, it’s just a tv show made by Fallout fans. Other than that, I haven’t heard of anyone else.

The Fallout wiki has a lot to say about ghoul physiology and among other things it states that some ghouls do turn feral at some point or another, and that it tends to happen more often to isolated and lonely ghouls. This information isn’t accessible in-game because of a bug, but players were supposed to be able to find it in Underworld in Fallout 3:

As the reasoning and high order thinking portions of the brain deteriorate, the Post-Human subject becomes increasingly hostile, giving into a carnal need to feed as opposed to the capacity for thinking that reasoning that a typical Necrotic Post-Human retains. It remains unclear exactly what precipitates this change in biology and psychology, but anecdotal evidence seems to indicate that non-social ghouls, or those in isolation, are more prone to the condition.”

This seems to prove that some intelligent ghouls can turn feral. The theory is supported by the fact that the mutation that ghouls undergo doesn’t affect higher reasoning functions. The same Fallout 3 entries in Underworld that were cut out of the game due to a bug say that ghouls have mutated neurotransmitters that affect the cardiac and respiratory systems, which grants them their longevity: they may rot on the outside, but the internal organs are still supplied with blood and oxygen. But the brain remains just the same, according to these entries and isn’t affected by the mutation directly. This is kind of surprising, considering the fact that ghouls can live over 200 years without losing any of their mental capabilities. We know that normal humans are far less likely to keep their higher cognitive functions and mental speed - even 70 years old are significantly worse at it than younger people. Yet here we are, talking about 200 years old ghouls that are mentally just as capable as before the War yet supposedly don’t have mutated brain tissue. Maybe the game suggests that the brain is kept by the organism in a good condition because it doesn’t suffer from lack of oxygen and blood at all (again, mutated neurotransmitters that affect the cardiac and respiratory systems). Anyhow, this is what I’m getting at:

If a ghoul’s brain is in the end no different from a human’s then it has to be susceptible to similar diseases. Like different forms of dementia. Something about 20% of the over 80 years old are diagnosed with Alzheimer dementia. At its final stages when the person becomes completely disoriented and incapable of caring for themselves, symptoms like aggression and hallucinations are pretty common. Note: aggression. Feral.

So, I suppose it wouldn’t be a stretch to say that ghouls can be affected by dementias as well? Especially if the game states that their brains aren’t directly affected by mutations. And social contacts, dealings with other people, whether pleasant or not, keep your mental functions from deteriorating. Not every isolationist ghoul does turn feral (remember Eddy Winters from Fallout 4 - but, then again, he was a criminal and not a very social guy), but it isn’t high science that a brain needs new information, stimuli, thoughts - anything to keep working fine. So this might explain why socially isolated ghouls lose their minds sooner than their brothers and sisters.

If this is something that awaits every ghoul at one point or another is hard to say. Like I already mentioned, only 20% of the over 80 years old are diagnosed with dementia - after that the percentage goes down. So maybe in order to go feral one would have to be in the dementia risk group. Or maybe the dementia ghouls are faced with is unique and affects everyone at some point. I suppose, it is a matter of debate, and everyone is welcome to join if they have some thoughts to share.

Now, Hancock isn’t a socially isolated fellow so I think it is safe to say that he isn’t part of this risk group. We know however that he is a drug user. We also know from Fallout 3 that ghouls need a higher dose of a drug to get high at all, thus, the ultra-jet, which is so strong that the dependency from it is incurable. So just imagine how much of this stuff Hancock is inhaling, inducing, swallowing and drinking. It would be a large amount for a human, but it must be a tremendous one for a ghoul. Drugs alter our perception of reality by changing or disrupting the process of neurotransmission. Ghouls do have mutated neurotransmitters, as it turns out, but none that affect the brain directly. So Hancock is in bad luck, and no neurotransmitters are going to save him from the damage he is doing to his brain - sad but true.

This could mean that despite Hancock’s obvious social personality he has a risk of becoming feral one day, maybe much sooner than other ghouls.

On another note, I do not quite understand how neurotransmitters can affect only the cardiac and respiratory systems. They should affect the brain as well.

And since this turned into a ghoul physiology post, I will take this opportunity to shortly talk about something else: Billy Peabody from the Kid in a Fridge quest.

Whether or not ghouls need water and food has been a matter of discussions for a long, long time now. It seemed like the games wanted to keep it vague to make the matter seem more mysterious. Now, a lot believe that ghouls don’t need to eat or drink because they can keep functioning by absorbing radiation. This is probably part of the reason why the developers believed that creating Billy Peabody was a good idea - with this quest they ultimately proved that theory.

Now let me tell you, this quest is bullshit - for two reasons.

Reason 1: The Vault Dweller talks to the Ghoul Leader in Necropolis

 Ghoul leader: "{132}{} {You aren’t thinking of taking the Water Chip from us are you?}“
The Vault Dweller: ”{135}{} {Why?}“
Ghoul leader: ”{136}{} {If you take the Water Chip from us, then we will all die. With our water pump broken we need it to survive.}“

This proves that ghouls do need water. He doesn’t say anything about food, but it proves at least one half of the theory wrong. And I see no reason why a creature’s organism would require only water but no food.

Reason 2: Billy Peaboy is still a child after 200+ years. This is a new idea. It is a new idea that contradicts both Bethesda’s lore and the original lore of the first Fallout games.

In Fallout 3, Carol from Underworld says that when the bombs dropped she was only a child. Not a teenager, a child. She was just as exposed to radiation as everyone else in the Underworld, and says that “when things quieted down” they started to turn into ghouls. The process took “long, months, maybe a year”. This in all probability means that Carol was still a little girl when she started to turn, and yet she looks like a full-grown woman.

In Fallout 2 you can meet a character named Typhon who is especially interesting for this debate. Typhon is Seth’s son and was exposed to radiation since childhood, and literally grew up with the condition. Furthermore, the fact that he hasn’t known anything besides a state as ghoul helped him adapt to the ghoulification better than anyone else, which is why he looks slightly different from the other ghouls and has paler skin. He is NOT a child. He is even described as an “elderly” ghoul. And this does not look like a kid either:

As usual, Bethesda makes a habit of breaking its own lore and the original lore of the first Fallout games. With Fallout 4 being the newest game and Bethesda most likely continuing to develop the series, I would expect that they are going to hold on to the idea that ghouls don’t need water, food and don’t age or grow up, despite the fact that some of these ideas they themselves didn’t support in their previous game. What to make of it is, in the end, a personal decision - whether to accept it or to fight against it - but with Bethesda continuing to build their own world with their own canons with little regard to previous ones, it will get hard to ignore it, eventually. Again, very sad but still true.

Fact is, Billy Peobody doesn’t make any sense, and Bethesda would have seen it if they paid a little more attention to their own games.

As a summary of this wall of text: intelligent ghouls can turn feral, especially if they are isolating themselves from society; a certain form of dementia might be one of the causes of this process as well; Hancock is risking becoming a feral ghoul because of his behavior regarding drugs; ghouls NEED water and ghouls DO age if they started to turn at a young age.

My Uworld notes- 6
  • serum sickness is a type 3 HSR characterized by deposition of circulation complement fixing immune complexes and resulting vasculitis. Associated findings include fever, urticaria, arthralgias, glomerulonephritis, lymphadenopathy and a low serum c3 level 5-10 days after intravascular exposure to antigen. type 3 HSR typically activate complement at local site where immune complexes containing IgG and or IgM complement fixing antibodies have been deposited. This often results in hypocomplementemia including decreased C3 level

  • liver dz-a/w AFP

  • carcinoembryonic antigen (CEA) a/w colorectal cancer

  • CA125 -ovarian cancer. Both CEA and ca125 are fr monitoring purposes

  • PSA prostate specific antigen is most useful in establishing extent of prostate cancer and evaluating response to prostate cancer tx.

  • Iced water think cold – cold think cold agglutinins – cold agglutinin associated with infection with mycoplasma pneumonia

  • another cold agglutinin is EBV

  • free air in peritoneal cavity= bowel perforation

  • pancreatic calcification= chronic pancreatitis

  • heavily calcified vessels = atherosclerosis and vascular dz

  • distended bladder= urinary retention

  • air in billiary tract a/w gallstone ileus

  • fluoxetine a/w anorgasmia and decreased libido and increase latency to orgasm. They can however be used to tx premature ejaculation

  • phenelzine= MAO-I used in tx of depression monoamine oxidase is a mitochondrial enzyme that deaminates primary and secondary aromatic amines

  • tricyclic antidepressants can cause orthostatic hypotension example imipramine

  • trazadone- priapism

  • paroxysmal breathlessness and wheezing in young patient unrelated to ingestion of aspirin, pulmonary infection inhaled irritant stress and or exercise should raise a strong suspicion for extrinsic allergic asthma. The granule containing cells in sputum are most likely eosinophils and the crystalloid bodies are most likely Charcot Leyden crystals (contain eosinophil membrane protein)

  • chronic eosinophilic bronchitis in asthmatics involves bronchial wall infiltration by numerous activated eosinophils largely in response to IL5 released by TH2 cells

  • digestion and absorption of nutrients primarily occurs in small intestine. SI cells produce enzymes responsible for nutrient absorption. Proteins in ingested food exist primarily as polypeptides and require hydrolysis to dipeptides tripeptides and amino acid for absorption. Hydrolysis of these polypeptides is accomplished by proteolytic enzymes such as pepsin and trypsin

  • these enzymes are secreted inactive proenzymes trypsinogen and pepsinogen from stomach and pancreas

  • trypsin activates other proteolytics enzymes including chymotrypsin carboxypeptidase and elastase. Activation of trypsinogen to trypsin is achieved by enteropeptidase (or enterokinase)an enzyme produced in duodenum

  • enteropeptidase deficiency results in defective conversion of trypsinogen to active trypsin

  • lipase secreted from exocrine pancreas is the most important enzyme of digestion of triglycerides. Chronc pancreatitis is a painful condition that causes lipase deficiency. This leads to poor fat absorption and steatorrhea

  • secretin is a peptide hormone secreted by S cells of duodenum un response to low duodenal pH. Secretins timulates secretion of bicarbonate from the pancreas and gall bladder and reduces acid secretion in the stomach by reducing production of gastrin. Neutralizing the acidic pH of food entering the duodenum from the stomachis necessary for proper function of pancreatic enzymes (amylase, lipase)

  • trisomy 18 (47XX: Edwards syndrome

    • face: micrognathia, microstomia, eye defects (microphthalmis, cataracts) low set ears and malformed ears prominent occiput

    • CNS: microcephaly, neural tube defects (meningocele, anencephaly), holoprosencephaly, arnold chiri malformation, severe MR delayed psychomotor development

    • musculoskeletal: clenched hands with overlapping fingers (index finger overrides the middle fingerand fifth finger overrides the fourth finger) rocker bottom feet short sternum and hypertonia

    • cardiac: VSD, PDA

    • distinguishing features: clenched hands and or overlapping finger

    • GI: Meckel diverticulum, malrotation

    • ultrasound: intrauterine growth restriction and polyhydramnios especially ina fetus with abnormal hand arrangement

  • unlike patients with Edward’s syndrome neonates with Patau syndrome (trisomy 13) have cleft lip and palate, polydactyly and omphalocele. Patau syndrome is not a/w low set ears and overlapping fingers but do present with rocker bottom feet also

  • 47XXX karyotype is clinically silent however, some affected women have slightly decreased IQ scores. Female newborns with this karyotype are phenotypically normal with no obvious dysmorphism

  • 47XXY Kleinfelter’s syndrome: may be a/w mild mental retardation or normal intelligence. The typical patient is tall mall adult with gynecomastia small testes and infertility. Male newborns with this karyotype are phenotypically normal with no obvious dysmorphism. The clinical findings do not become apparent until adulthood.

  • Sudden onset of abdominal or flank pain hematuria and left sided varicocele together suggests renal vein thrombosis a well known complication of nephrotic syndrome. Nephrotic syndrome is a hypercoagulable state d/t increased loss of anticoagulant factors especially anti thrombinIII (responsible for the thrombotic and thromboembolic complications of nephrotic syndrome)

  • venous drainage from left testes travels throught the left testicular vein into the left renal vein and from there the IVC. In contrast to the right testicular vein which empties directly into the IVC. This difference in venous drinage gives diagnostic significance to left sided varicocele in that it often indicates an occlusion of the left renal vein by a malignant tumour or thrombus

  • malaise low grade fever followed by a facial rash. Feels better now but still has the rash- red flushed cheeks with – clinical presentation of erythema infectiosum aka fifth dz. As the facial rash fades an erythematous rash in reticular lace like pattern often appears on trunk and extremities. The rash of erythema infectiosum is thought to result at lest partly from local immune complex deposition once serum levels of virus specific IgM and IgG have attained high enough levels.

  • Erythema infectiosum= non enveloped DNA virus called parvo B19. The blood group P antigen globoside is a parvovirus B19 is highly tropic for erythrocyte precursors particularly erythrocytes and erythroid progenitor cells

  • Parvo B19 replicates predominantly in the bone marrow

  • anthracyclines daunorubicin doxorubicin epirubicin and idarubicin are chemotherapeutic agents a/w severe cardiotoxicity because of their unique ability to generate free radicals.. Dilated cardiomyopathy is dose dependent and may present months after discontinuation of the drug . Swelling of sarcoplasmic reticulum is the morphologic sign of early stage doxorubicin associated cardiomyopathy. Followed by loss of cardiomyocytes and its symptoms are those of biventricular CHF including dyspnea on exertion orthopnea and peripheral edema

  • dexrazoxane prevents Doxorubicin associated cardiomyopathy because dex is a iron chelating agent that decreases formation of free radicals by anthracyclines.

  • Restrictive cardiomyopathy a/w hemochromatosis amyloidosis sarcoidosis and radiation theraapy : remember -osis

  • hypertrophic cardiomyopathy caused by mutation of beta myosin heavy chain

  • focal cardiomyopathyscarring commonly results in MI

  • pericardial fibrosis usually follows cardiac surgery radiation therapy or viral infections of the pericardium

  • PCP aka angel dust aka phencyclidine commonly associated with violent behaviour

  • LSD can also cause aggressive behaviour but it is more typically characterized by affective liability thought disruption )delusion) and visual hallucination whereas PCP produces more psychomotor agitation including clonic jerking of extremities

  • angel dust can be put on marijuana and smoked LD is ingested orally

  • secobarbital is a street barbiturate a CNS depressant which leads to drowsy drunken state of consciousness without the violent behaviour

  • heroin (opioid) produces CNS psychomotor depression and respiratory depression miosis and bradycardia are common

  • dry tap with no splenomegaly or lymphadenopathy – think aplastic anemia which causes pancytopenia

  • aplastic anemia= hypo cellular bone marrow with fat cells and fibrotic stroma

  • hyper cellular marrow with increased blasts found in myeloproliferative d/o and certain leukemias

  • most common side effect of streptokinase= hemorrhage . Streptokinase is a thrombolytic agent that acts by converting plasminogen to plasmin which subsequently degrades fibrin. It is a foreign protein derived from streptococci and induce HSR.

  • Dissection of ascending aorta manifests as tearing chest pain that radiates to the inter-scapular area commonly occurs in hypertension marfans and ehlers danlos

  • hyperactive jaw jerk reflex when lightly tapped= chvostek’s sign- Hypocalcemic – facial m contraction elicited by tapping facial nerve just anterior to ear. The most common cause of outpatient hypocalcemia is primary hypoparathyroidism which is often d/t prior loss of parathyroid tissue during thyroidectomy

  • scotoma is visual defect that occurs d/t pathologic processes that involve parts of retina or optic nerve resulting in discrete area of altered vision surrounded by zones of normal vision. Lesions of macula cause central scotomas.. examples would include MS, diabetic retinopathy and retinitis pigmentosa

  • verapamil is a calcium channel blocker that slows SA and AV node phase 0 depolarization (in nodal cells, the phase of depolarization is mediated by calcium influx)

  • phase 0 depolarization of cardiac conduction system occurs during diastole thus verapamil slows diastolic depolarization

Herb of the Week Lily of the Valley


Lily Convalle
Lily of the Valley
May Lily
The plant commonly called the lily of the valley is a nice-looking perennial that can reach a height of about nine inches or twenty three cm when fully grown. The morphology of the lily of the valley consists of a pair of elliptically shaped leaves, with many clusters of distinct bell shaped and white colored flowers along one side of the stem, and distinctive red berries in the fruiting season.

The bell shaped flowers of the plant are very familiar to floral enthusiasts and while they are certainly small and unspectacular, they are very sweetly perfumed and are a universally well liked flowers. The lily of the valley is a very hardy plant and it can very readily adapt to a wide range of growing conditions in the wild, the plant is quite common now in the north American country side and even though the sturdy little herb thrives is not a native it thrives on neglected waste grounds and has escaped from many gardens to become a common plant in North America.

Keep reading


If you answer any of these I’ll send you a Christmas card. Or not, if you don’t want, but I’ve already promised my first born to someone, and besides, everyone loves Christmas cards

  • Amount of blood pumped out of the left side of the heart per minute (7,6)
  • The thin inner layer lining large blood vessels (11)
  • Cardiac muscle is described as this because it beats on its own (8)
  • Name of vessels which allows blood to by-pass capillary networks (5)


Mandatory question mark: ?

Pray for my mother, Lezlie McCoy

My mother had a stroke last Thursday. She had a hemorrhage (meaning that a vessel in her brain bursted). It bursted near her brain stem (the most important part of the brain. Her brain was and still is bleeding. There was also swelling in her brain. She fell into a coma. The doctors said that this was it for her. I tried to accept that but could not, because she is my mother. She woke up, thank God the very next day.

Her right side does not move for the most part. She couldn’t breath on her own. Little by little she is improving.

One day, she was not doing anything today but when I started to pray her eyes opened at 5:30am. I was discouraged and I began to trust again. I started praying with her, reading the word to her and singing to her.

Around 5:30am as I began to sing her eyes started opening. She started responded to commands. She waved at me. I even did a recall of her memory. She is even responded to many of the doctors commands. She also nods her head in agreement slightly.

Since then she has started to breach on her own, is on a feeding tube, with very damaged kidneys is on dialysis, and has had a tracheotomy.

Today, a little over a week later, the doctor wants to give my mother a CT scan, because again he is concerned that she is still so sleepy. He says that the bleed may have or may not have gotten bigger. My mother is very tired.

I ask that we praise God in advance. I ask that we claim, accept and receive that my mother, LEZLIE MCCOY, is healed and fully recovered. The doctors have knowledge but they are not GOD. So I ask that we take it up a notch TODAY prayer warriors. Let’s pray and meditate harder. God has more work for my mother.

Please pray for LEZLIE MCCOY:

1. That LEZLIE MCCOY fully wakes up

2. Full recovery of all of LEZLIE MCCOY’s non-voluntary functions (MOST CRITICAL- neurological, cardiac, respiratory, digestive system)

3. That LEZLIE MCCOY’s brain fully heals

4. That the arteries in LEZLIE MCCOY’s right leg, left leg and entire body function normally

5. That LEZLIE MCCOY will see (correct vision).

6. That LEZLIE MCCOY FULLY recovers

7. That LEZLIE MCCOY goes back to her old self but even stronger

Upon recovery:

1. Great memory and control over LEZLIE MCCOY’s bodily movements

2. That LEZLIE MCCOY has no relapse whatsoever

3. That LEZLIE MCCOY can enjoy her life again

Prayer warriors we expect an even greater miracle. Despite what the doctors may say or believe, LEZLIE MCCOY will fully recover.
Lift my mother, LEZLIE MCCOY up in prayer. God is able, and he promised that he would provide a full recovery for my mother.

Let’s go prayer warriors

I cannot wait to hear her talk and laugh again. She has a loving husband, mother and family. GOD IS ABLE.

Please spread the word and pray hazard.

Journal entry 10:50 p.m. March 1, 2016

we talk about things that spin around themselves:

         a returning kite string

                 the world - both forward and in reverse

        unwelcome thoughts

                 my arms around you


                 my clumsy sentence structures

        the word “okay”

                 your music playlists

        the cardiac system

                 your arms around me

                          and we speak this way until we are spinning so fast 

                          that, for a moment, we cease moving at all.