About all these medical test scenarios...

[AriesWolf]

I've noticed that when someone starts talking about werewolves and doctors, i.e. 'what would happen if one had a checkup?', it usually doesn't take long for people to mention DNA. But the thing is, most of the things people list as reasons for a werewolf to seek medical attention wouldn't cause a doctor to look at the DNA. If you go to a hospital complaining of chest pain, they might take a blood sample, but it won't be for a DNA test. Probably platelet count or something, but I don't know for sure. Let's say you have a werewolf-bite victim that actually has the brains to go to a hospital after the symptoms start (I'd visit the ER once the fever and nausea started). The staff is going to take all kinds of samples off you, everything from blood to urine, to swabs and maybe even tissue samples from the wound itself. They won't do DNA tests on any of that either. Why? Because they're looking for the cause and best treatment of an assumed bacterial infection, and you don't need DNA for that. Even if they ran a test on cultures from the wound itself, and let's say they find some sort of canine DNA, they'll assume the victim was bitten by one, not that he is one.

Now, for something a little different. Let's say by the time our hypothetical victim sought treatment the wound had already healed up, leaving no trace. Since it's already healed so well, he doesn't mention being bitten by anything recently. The medical people would start looking for bacteria. When that failed they'd check for viruses, which also don't call for DNA testing. Still nothing. Maybe now they'll look for heavy metal poisoning. Still no reason to take DNA samples. If there was some type of rare disorder that matched the victim's symptoms closely enough to check for the genetic markers that would indicate they might have it, THEN, I could see them looking at DNA, but it would be one of the last things anybody thought of, since standard practice is to eliminate all the obvious things first. And by then, enough time might have passed for the change to be nearly complete. Which would mean the symptoms would have died down enough for the victim to decide whatever was wrong with him must've run its course, thank the medical staff, and go home. And then get the shock of his life a few days later...

Anyway, that's my opinion on it; what's yours?

[Uniform Two Six]

"Scott Gardener" is our resident medical expert. My advice: next time just entitle the thread "Hey Scott! Medical question!" I'm sure the doctor will see you soon.

Anywho, I've got a question for you. How come it's got to be DNA? Remember genes code for what your physical characteristics, your biology, is. If you are physically a human (when they try to diagnose you), why wouldn't your DNA be entirely human? In other words, if the whole organism can shift, why would the DNA remain the same instead of mutating during the transformation? Human DNA in human form, canine DNA in wolf form, and some weird freaky amalgam of the two in hybrid form.

[AriesWolf]

"Scott Gardener" is our resident medical expert. My advice: next time just entitle the thread "Hey Scott! Medical question!" I'm sure the doctor will see you soon.

Anywho, I've got a question for you. How come it's got to be DNA? Remember genes code for what your physical characteristics, your biology, is. If you are physically a human (when they try to diagnose you), why wouldn't your DNA be entirely human? In other words, if the whole organism can shift, why would the DNA remain the same instead of mutating during the transformation? Human DNA in human form, canine DNA in wolf form, and some weird freaky amalgam of the two in hybrid form.

I see what you're saying. I would say it DOESN'T have to be DNA; I used that because that's what I've seen folks talk about. And I'm not as clever or creative as some of the other people here .

Actually, now that I think of it, I've seen people bring up plenty of other medical "tells"; DNA just seemed to me the one least worth being so concerned about because there's such a small chance of anyone checking it.

[Uniform Two Six]

In my humble opinion, the biggest medical "tell" would be scars and stuff suddenly disappearing overnight (assuming your particular flavor of werewolf has regeneration -- and there's whole threads dedicated to that debate).

[Terastas]

I never really bought into the whole "rewriting DNA" either. I always attributed the shift as being more akin to a deformity than a mutation, and if I was a werewolf, I'd be more worried about my blood tests than any examination of my DNA.

I think the DNA confusion stems from two common misconceptions:

1) Werewolves are a separate species.
2) Blood = DNA.

Unless werewolves were an entirely different species not capable of infecting humans (and I've covered why I don't believe that in many other threads already), werewolves would be a subspecies at best. What werewolves are reputedly capable of is indeed pretty fantastic, but a complete species change is simply not possible. For werewolves to be capable of turning other humans into werewolves, they would have to be humans themselves (albeit with a remarkable affliction), which would in turn mean they would retain their human genetic code.

The latter misconception I think is owed to the fact that most of us were first introduced to DNA by Jurassic Park, which pretty much broke the science down to just "blood = DNA." The most common attributed form of infection is through blood, so the Jurassic Park misconception may have carried over into a misconception about lycanthropy: the assumption that any affliction in the blood stream works by attacking and/or altering the DNA.

Mind you, I'm no doctor, but if I had to guess, I'd say that's why people get confused every now and then. I could see lycanthropy behaving in relation to the host's DNA, but not influencing or altering it directly. Lycanthropy does many crazy things to the human body, but a werewolf is still a human being in my book.

[Uniform Two Six]

One of the other things I liked about the werewolves in old Werewolf: The Apocalypse was the aspect of the werewolf/wolfwere thing (called Homid and Lupus), in which Lycanthropy was found not only in humans but in wolves as well. One of the many little quirks of that game was that the two often had entirely alien perspectives on just about everything.

[Scott Gardener]

Vrrr!!! Vrrr!!! (click) Deet! Deet! Deet!

Ack! Sorry I'm late! I didn't know I was on call, so I left my pager on vibrate when I dropped it in the toilet, while the dog ate my cell phone. OK, medical questions...

We don't routinely test people's DNA. That's forensics and criminal investigations. If someone comes into the ER with chest pain, I'm likely to order the following:

1. an EKG--a twelve-lead tracing of the electrical activity of the heart. This shows abnormal conduction patterns that suggest that portions of the heart could be starved of oxygen from a heart attack. I would not think a werewolf would show any of these abnormal tracings or any other funny-looking changes in the zig-zag patterns.

2. A chest X-ray--this shows what the heart and lungs look like. In a heart attack, we often won't see anything abnormal, oddly enough. Pneumonia shows up as fuzzy areas in the lungs. An enlarged heart can be a sign of long-term problems. Again, I wouldn't expect a werewolf in human form to have anything obviously visible, as wolves and humans have very similar chest anatomy outside of the barreling of the chest and segmentation of the canine sternum.

3. A "CBC" ("comprehensive blood cytology")--this is part of routine blood labwork done on most ER visits and during most hospital stays. It's not specifically looking for anything related to a heart attack. Instead, it's part of the process of looking for anything else going on. It includes a WBC (white blood cell) count, which is typically 4-10 in healthy people and higher in people fighting off infections or inflammation. Counts above 20 in otherwise healthy people or 16 in frail elderly are bad enough to put people in the hospital. Children and pregnant women will have higher WBC counts just due to normal human physiology. Canines have a typical WBC count of 6-16, so a healthy werewolf could be misdiagnosed with some form of infection. (Which, by some schools of thought, would actually be true, I suppose.) CBCs also check red blood cells, principally with the "H and H"--the hemoglobin and hematocrit. A typical hemoglobin is 12-14, though I often see them as low as 11 without thinking too much about them, depending on the person. Less than that is anemic, and less than 8 is bad enough to warrant transfusing. The hematocrit is just about always roughly three times the hemoglobin. Canines have slightly higher values than 12-14, but healthy young men can have similar values, such as a hemoglobin around 15-17. A werewolf probably would have an elevated hemoglobin, but this would probably be overlooked, or perhaps mistaken for dehydration. We do check platelet counts, but again, werewolves wouldn't have any reason to have abnormal platelet counts, unless the virus or virus-like replicating factor were large enough for the lab equipment to mistake it for platelets, creating a false high value. In this case, it might be barely visible under a pathologist's microscope at the highest setting (1000x), but he or she would have to be looking for it actively in order to notice it. In my novel, some researchers do see it. But, it would be fuzzy and indistinct, not the grandiose eye-popping special effect that movies typically show.

4. A "CMP" ("comprehensive metabolic panel")--this is a test of blood chemistry--salt ions, liver proteins, and amino acid and enzyme break-down products that are filtered by the liver and kidneys. Most of these are similar in humans and other mammals, though wolves concentrate their urine a little more than humans do, causing "BUN" (blood urea nitrogen) and "creatinine" values to run a little high, enough that a werewolf probably would be misdiagnosed with dehydration or asked about high blood pressure or diabetes in the family before being counciled about risks of kidney problems. Some of the liver enzymes may also be somewhat elevated in wolves compared to human norms, but I'll see similar slight elevations in real people fairly often due to the popularity of alcohol.

5. "Cardiac enzymes"--CK, CK-MB, and Troponin I. CK, or Creatine Kinase (not to confuse with that other kidney thing), is a muscle breakdown product. It's elevated after muscle injury, and thus elevated after heart attacks. But, it's also elevated after strenuous activity such as a workout or after anything that causes muscle breakdown, such as side effects from certain cholesterol-lowering medicines. I'd have a hard time imagining the CK NOT being blatently through the roof in a werewolf who has shifted form in the last 24 hours or so, so a werewolf could almost expect to be misdiagnosed with "rhabdomyalysis," or the breakdown of skeletal muscle. A werewolf could be mistaken for a heat-stroke victim and given boluses of IV fluids as treatment. The CK-MB is a sub-type of CK specific to the heart, to help distinguish workouts and rhabdomyalysis from heart attacks. Troponin is another test for heart-specific muscle breakdown products, and it's very specific for heart attacks and heart failure. I'd expect both CK-MB and Troponin to be normal in werewolves as long as they're not just happening to be undergoing a myocardial infarction at the time.

6. "Coaggulation panel," or PT, PTT, and INR--these test clotting times. They're normal in most people, but in modern medicine, we actually try to make them abnormal in a number of patients. We want these numbers higher in people who are at risk of having a heart attack, stroke, or blood clot embolus lodging in the lungs. So, to do this, we give, I kid you not, carefully measured doses of what is effectively rat poison. (It's called Coumadin; we don't actually recommend rat poison itself.) Then we check these labs very frequently to make sure we're giving the right amount and not raising these numbers too high! Humans and wolves should have similar values.

7. In women, a pregnancy test, or "hCG"--human chorionic gonadotropin. I'm not sure how similar wolfie chorionic gonadotropin is to hCG, but both are only elevated in women who have babies in them.

8. Although it's not frequently ordered in chest pain per se, "Amylase" and "Lipase" are often ordered in cases of abdominal pain. Both are digestive enzymes made by the pancreas, and if both are elevated in someone with abdominal pain, I'll admit the person to the hospital for pancreatitis, a fairly serious infection or inflammation problem. (It can indeed be extremely serious, depending on its severity.) Wolves naturally have values a bit higher than humans, so a werewolf experiencing writhing pain from an impending shift could be misdiagnosed with pancreatitis.

9. UA--Urine analysis--looks for signs of a urinary tract infection or other strange problems. Diabetics will tend to spill glucose and sometimes ketones into their urine. I don't see anything unusual that werewolves would have in their urine, although as a bodily fluid, it's likely contaminated with the lycanthrope virus.

10. Urine drug tests, serum (blood) alcohol--nothing specific to canine physiology would cause false-positives, and I don't see how endogenous hormones could set off false positives, as the tests are pretty specific for their drugs. But, I can see a werewolf underground using illegal pain killers and sedatives to help get newly afflicted werewolves through painful first shifts.

With the exception perhaps of an astute pathologist with a good quality microscope and a high index of suspicion, and a virus big enough to see in that particular storyline universe, none of these are things that specifically indicate lycanthropy. Most lead to misdiagnoses of other problems ranging from heat stroke to pancreatitis, to "idiopathic rhabdomyalysis"--some could land one into the hospital if one looked sick, such as going towards one's first shift. But, they might be managed outpatient in a healthy-looking individual undergoing routine screening. Typical outpatient routine physicals might do an EKG, a chest X-ray, a CBC, and a "BMP"--a "basic metabolic profile," which is a CMP minus the liver enzymes. Other than dehydration, not much out of the ordinary would show up, except a nagging elevated white count suggesting that there's an infection somewhere...

[RedEye]

Hmmm... If the sample tried to crawl out of the Vacutainer and bite the technician, that would be a pretty good indicator that there was something unusual happening.

Anyway, unless medical science has gone a heck of a long way since my last visit to the doctor, a genetic examination takes weeks to do...
And even the worst Emergency Rooms don't make you wait that long for treatment...
although it may seem that way...

[Terastas]

[everything]

Umm. . . You know, I think I actually followed most of that.

It's awkwardly convenient too, because if I read everything correctly, the most common misdiagnosis would be dehydration, which is what I figured would be what werewolves would be most susceptible to once lycanthropy makes itself at home in their immune systems and starts flushing out everything it doesn't like via the colon.

Those were all in order, right? Like if the problem wasn't evident in the first, you'd take the second and so on and so forth?

[Wingman]

Well Scott left out one very important medical device, the machine that goes 'Ping!'.

Hmm, if people have allergies concerning animals, would they be allergic to werewolves as well? On the flip side, could there be werewolves allergic to humans?

[Uniform Two Six]

We don't routinely test people's DNA. That's forensics and criminal investigations.

And we (in law enforcement) do it extremely rarely. Genetic testing is expensive, time-consuming, highly vulnerable to sample contamination, and most importantly, is very difficult to explain to a jury made up of lay-persons whose closest experience is watching BSI... Er, I mean, CSI.

[Terastas]

Well Scott left out one very important medical device, the machine that goes 'Ping!'.

That's only if the werewolf is pregnant.

Hmm, if people have allergies concerning animals, would they be allergic to werewolves as well? On the flip side, could there be werewolves allergic to humans?

Possibly. Mind you that people aren't necessarily allergic to animals so much as allergic to animal dander, so even a werewolf in full wolf form wouldn't be enough to trigger an allergic reaction just by itself, if only because it couldn't have been in that form long enough to produce enough dander to cause an allergic reaction.

Which is also why nothing can be allergic to humans: because we're mostly hairless.

[RedEye]

Keep in mind that dander is mostly shed skin cells, and Humans shed more of those more consistently than any wolf does.

And surprisingly, there are Humans who are allergic to other Humans... It's rare, but I've read about it not that long ago. I just wish I'd noted which book or journal I read that in...drat!
Frequently, this strange allergy is caused as much by diet (which has a profound effect on the skin) as much as anything else. Eat too much garlic, and your sweat will smell of garlic, which means that there is garlic ester present in the skin cells that are shed as well (example).

I guess that it would be most pronounced with racial difference, since that's where we differ the most: that 3/32 of an inch on the outside of our bodies.

[Scott Gardener]

If by "ping" you mean, "bip, bip, bip, bip," you probably mean the pulse oximeter. That's the little thingy that they put on your finger, that blinks a red light. It's what makes the musical beeping during surgery. A healthy human has a pulse oximetric reading of 97-100%. People with emphysema (or "COPD," chronic obstructive pulmonary disease) may run slightly less, but anything below 90% is pretty much invariably a sign of serious problems. I'd expect blood oxygen to stay good in a lycanthrope. Indeed, this may be one area in which being human without lycanthropy could be better--a werewolf would need a pulse ox. number to stay good even more, due to the higher metabolic demand. That makes for shorter dives, and it makes my character's second career as an astronaut in the 2040s a bit of a challenge.

Allergies: I would expect immunological lycanthropology to be a messy subject with lots of hard-to-follow content about modifications to such-and-such cellular receptors and binding proteins. But, in a nutshell, I'd think that werewolves wouldn't suddenly develop an allergy to anything new, to which they weren't already allergic. Some people might have problems with autoimmune reactions--ironically, symptomatically similar to a real disease with the curiously coincidental name of lupus. But, I don't see werewolves sneezing around humans, unless it's psychosomatic.

[Uniform Two Six]

If by "ping" you mean, "bip, bip, bip, bip," you probably mean the pulse oximeter.

Scott, I'm enormously disappointed that you didn't get the Monty Python's The Meaning of Life reference. Truly one of the single greatest masterpieces of modern cinematography. For shame.


"That's the machine that goes "Ping!" That's the most expensive machine in the whole hospital!"

The machine that goes "Ping" was good, but I particularly liked The Really Big Corporation of America.

[Wingman]

The Machine That Goes 'Ping!'.

"The Administrator's coming! Quick, turn everything on!"

I'm not sure if anyone here has played PROTOTYPE, but there are viral detectors that can, somehow, detect infected individuals. Namely you, the main character. I ponder if such a thing could be rigged up to detect werewolves.

[AriesWolf]

The Machine That Goes 'Ping!'.

"The Administrator's coming! Quick, turn everything on!"

I'm not sure if anyone here has played PROTOTYPE, but there are viral detectors that can, somehow, detect infected individuals. Namely you, the main character. I ponder if such a thing could be rigged up to detect werewolves.

Probably, as long as they knew EXACTLY what to program the machine to look for. Otherwise, I think you'd have a big mess on your hands.

[silver1]

would'nt that be a bad thing though?

[Scott Gardener]

Thanks; believe it or not, I've never seen the Monty Python hospital sketch or the machine that goes "ping!" Thanks for helping me build my Geek Curriculum Vitae.

[RedEye]

Okay, since we've wandered into obscure medical sounds...

Can anyone tell me where the term "Pocketa-pocketa-pocketa" came from?
I do know the answer...
Do any of you?

[Scott Gardener]

The Secret Life of Walter Mitty

You do realize that you're posting a quiz question on the Internet, with Google just an Open In A New Tab away.

The bank of computers were crashing one right after another, filling the IT department headquarters with a clunky pocketa-pocketa-pocketa noise. "It's the whole network," Micheal explained. "The Duckie1 virus has already taken out the primary servers and has already gotten into half of the backup servers. This is beyond anything Symantec or McAfee ever dealt with." Mitty nodded. "You gave it your best, but I keep on hand a special code I wrote myself." He pulled from his keychain a USB thumb drive and inserted it into one of the infected computers before pressing 'control-alt-delete'...

[Scott Gardener]

It also dawned on me that I forgot one of the most blatantly obvious abnormality--vital signs! Specifically, core body temperature. Humans run a temperature of 37 C, or 98.6 F here in the U.S. Wolves run a bit higher; canines run about 38-39 C, or up to 102 F. I would expect a werewolf to run a high metabolism and have a body temperature closer to the upper end of wolf rather than a much cooler and less energy-intense human.

Or, as any Geek knows, 39.1 degrees Celcius... the temperature of a Borg ship...


Indeed, running a fever would prompt the workup that would reveal the elevated WBC count and the elevated amylase and lipase causing the werewolf to be mistaken for having pancreatitis--which is a very painful condition in which one guards one's belly and feels like crap. Thus, a werewolf about to undergo one's first shift should always be considered in the differential diagnosis of pancreatitis. So, I would advise any new intern physicians after reviewing Ranson's criteria to ask the patient whether or not he or she can recall any strange animal or paranormal creature encounters over the previous seven to fourteen days.

[Uniform Two Six]

Whew! With my 102 degree temperature I thought I might have H1N1, but now...
WHOO-HOO!!! Lycanthropy here I come!!!
*Dances around -- and then drops dead from encephalitis or something*

[Sharfan]

Yeah, Scott pretty much covered what I thought, and much, much more. I would just like to say that you would have to consider the possiblility of a werewolf coming in with life-threatening injuries. The doctors would take him (or her) to the E.R. (eventually). After everything is finished, and the lycanthrope is all bandaged up and cozy in bed, the doctors would probably start to suspect something, most likely from the swiftness of the recovery. I really don't know a whole lot about how an actual hospital works. But, I do know what my high school anatomy teacher tells the class constantly: document everything. So, when the patient completely heals say, a broken arm, in four days, I would venture to guess that the doctor would become curious. Now, this is where it's just a bit of chance. Depending on how dedicated they are, they may take it further, running many more tests, using the excuse of risk of new, unkown infection. They may not be able to find anything, depending on the many factors of werewolves that are not set in stone as of now, but the suspicion would still be there. My guess is that the whole reason they don't want to go to a hospital is because of the risk, no matter how small. They wouldn't know if the doctor would be able to find anything at all. If anything, I know that I wouldn't want to take any chance of the secret getting out. And, who knows? This doctor may be so certain that there is something about you that he start's up his own werewolf hunting group, and uses your file to track you down and kidnap you for testing. You just never really know.

[Wingman]

I now have a strong desire to see Doctor House diagnose a werewolf, though it's more likely that Doctor Walter Bishop would come across one.

Well, one thing to consider is that even if a werewolf does heal a broken bone fantastically fast, there might already be a cast on it. No one else might notice unless they do a followup x-ray. Even the werewolf themselves might not know, since they might be on painkillers, so any claim of "Wow, it doesn't hurt any more." might just be attributed to the painkillers. Though, they might notice if they've been on painkillers before and notice that they don't feel drugged.