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mleprae · 25 days ago

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may i have some more details about physical illness baldwin could suffer? exhaustion, unconsciousness, etc. since your post about sarmenti's irrational anger at his illness inspired me quite a lot, and more detail is better here!! he's so stalwart and strong in soul, i want to contrast the worst of his ailment against his unshakeable spirit

I had to write this on a google docs because there was just SO much text that doing it on a tumblr ask lowkey annoyed me. Sorry for any weird formatting issues or missing words!

I ended up writing this bible because I only realized later that you asked for general symptoms, and not ENL ones. Oh, well, I Italicized all the symptoms that are present in both leprosy and ENL, and just in case, I bolded and italicized the symptoms in ENL only.

Here’s the original thing I wrote!

If you are talking about that one post, I was talking about ENL / Type 2 lepra reaction specifically. My biggest mistake was never talking about leprosy reactions too much in-depth here, and it's partially because we don't know much about them! D: Despite being one of the most serious complications, we haven't explored why it exactly happens. (I know I say 'we don't know' alot about leprosy, but it's just because it's really really really hard to study it)

Leprosy reactions are some brief moments that the disease may develop new symptoms or become temporarily worse, we don't know what starts this, just that it's a type of hypersensitivity. (Which is what we call any blown-out-of-proportion immune reactions, allergies and autoimmune diseases are also hypersensitivities) These episodes are usually short (few days) but the longer and serious ones can last a month or two.

If I were to cite every single symptom during this episode + leprosy in general I'd be here forever, there's just so so sooo many!! But since you asked for the worst of the worst, here's the more severe + common ones. (I obviously cannot testify for myself that those are the worst symptoms because well, I probably will never catch leprosy, I'm quoting the ones where have been described as most life-threatening and the ones that are more inconvenient than others.)

The ADHD version: Amyloidosis (high amyloid count) - CKD (Chronic kidney disease)- Heart issues which may lead to heart failure - Fluid buildup in the limbs (especially the legs) Muscle issues- Muscle pain - Muscle weakness, trouble swallowing and chewing (Although it gets worse in ENL)

Bone issues- Severe bone pain, mostly on the longer bones like the tibia. Hip is also common but it’s more characteristic of any disease than leprosy-specific. (There are a lot of bone symptoms of general leprosy, but I don’t think any of them cause pain.)

Skin & nerves

-Painful nodules pop up throughout the entire skin, pressing on them is extremely painful. They may become pustules or necrotize. (Characteristic of ENL) - Nerve pain, usually worse at night time. Others - Overall malaise - Low to high fever, though if we are talking about ENL, it’s probably more to a high fever. High fever can make you delirious and confused. - Stuffy nose, trouble breathing. Something that haunts me is that dying suffocated to your own mucus/snot is not an uncommon death.- Headaches

The hyper fixated autistic version, in which I just yap about some specific details and add my jester x leper headcanons in the end. (just a complement to the ADHD version)

Full body pain We know that ENL is a type of hypersensitivity, which means that any tissue that has the leprosy bacteria in it becomes inflamed. If you’re having ENL, it probably means leprosy has you by the throat at this point, because it does not happen to any other leprosy types in which the bacteria population is small.

So muscles, nerves, eyes, bones, lymph nodes, skin, everything is invaded by millions of cells sending a shitload of chemical warfare. Inflammation is a destructive reaction, it helps you, but it is destructive in nature; Your immune system is not here to protect you, it’s here to destroy invading pathogens and it will do so by any means necessary. (Even killing you!) Not to mention, the body was already severely impaired before the invasion, a lot of people die during their ENL episodes because it just gets that bad, and if they recover, the damage is too severe to be healed.

All of this is extremely overwhelming to the body and to the person, everything gets swollen, pressing on those nerves that are already firing pain signals. I cannot state how excruciatingly painful all of this is. By the day, it can be something from low to mild pain but it becomes worse as the night falls, as it's usual with nerve pain.

So on top of all the pain, you have some muscle weakness. You can’t move or walk properly but laying down is also painful, trying to sleep becomes a challenge, it’s been noted that despite everything, most can only sleep very lightly. (When they can) A little trivia is that thalidomide, a drug originally used to help people sleep, can actually help in managing ENL. It was discovered when a doctor prescribed it to one of his leprosy patients to help him sleep during those episodes, and they discovered his condition improved afterwards, which is pretty neat!

Involving organs and whatnot

Amyloidosis might be like, 99% the reason why leprosy complications are fatal. Most of them will target the internal organs, like the kidneys, heart and the liver. It’s a little misfolded protein usually associated with long-term/chronic infections… and Alzheimer’s.

The protein causes fluid buildup in the limbs but also it can block important arteries to the heart, causing heart failure. (2nd leading cause of death, after suicide) But for the most time, it causes arrhythmia, which as someone who has a type of arrhythmia, it sucks, it does, alot. It hurts like hell, it makes you dizzy, it feels like your heart grows 4x in size and is trying to claw out of you via your throat. And I have the easy type!

Before I go on about anything else, I wanna go about diet, I already answered here about the complications of weight loss and leprosy and the reason behind it. (I do recommend reading it before this part) Amyloidosis causes CKD (chronic kidney failure), filtering the blood is pretty important… A failing kidney means increased blood pressure due to the fluid buildup.

If they don’t have any sort of knowledge on how nutrition works in the Darkest dungeon medical world, it could make things even worse. Salty foods and pork are the worst offenders, salt will increase your blood pressure by disrupting the osmotic balance, pork has too many fat/lipids, which stimulates the adipose tissue (the one responsible for storing fat), which in turns pisses the immune system EVEN more than it already is. (And this is why you’re advised to not eat pork after a tattoo) So that’s 3 strikes to the heart and 2 to poking the nuclear-tempered cells with a short stick.

As a complement to the original post, I forgot to mention why not only Baldwin isn’t eating properly but that he would probably be losing weight faster than he should. This is one of the more ‘gross’ symptoms you can’t lionize in fiction, but something that stuck to me alot was how the urine goes from liquid to a red, foamy thick paste. The kidney is also responsible for taking proteins instead of letting them go to waste, a dysfunctional one will just start discarding proteins, ESSENTIAL proteins, making the urine foamy or thick depending on which proteins are being discarded. (Red being from blood, which is another topic) Even if he was eating properly, his body can’t help but discard the food he needs. There's a wildfire in the distance of people fighting if intestinal leprosy is a thing and that can cause constipation. I’ll leave it up to you, most people do not believe it though.

My overall fandom Thots(™) In a selfish way, I think it’s fair that Sarmenti would be irrationally upset at it, considering everything, Baldwin would probably need to have some around-the-clock care as it happens IRL with ENL reactions (patients are supervised by nurses until the reaction is over and they can go home). I don’t think Sarmenti is caring for him directly though, it would be much much worse if he did; because he would need to help him eat, sleep, move around, change his wraps and clean him if needed. It makes more sense to me that Paracelsus is doing it, and Sarmenti is just there to visit or do some small things if he can, and even then, there’s not much she can do. While some leprosy antibiotics can be made by harvesting and refining things found in nature, even crudely, the ones that are used to manage ENL need high-tec labs and industrial wide scale production for it, there’s not many things to help it either, we didn’t even knew Thalidomide helped leprosy until like…1960? It’s not even recommended.

All that can be done is just wait until the reaction takes its course and doesn’t take his life with it, you can do some pain management to help him sleep better, but other than that? In this situation? I think they can only just make him as comfortable as possible and wait. In Baldwin’s POV, he’s in severe pain and discomfort, stuck in a room warm as possible as to not stir nerve pain. Confused/Delirious from fever and exhausted from lack of sleep, it’s normal for people in these states to just get up and… leave? Because they don’t know what’s going on or where they are, if he can still walk of course. Sarmenti depends on Baldwi emotionally, but it’s almost never the other way around, so this sudden change in routine is pretty upsetting for both of them. I think Baldwin needing him or “avoiding” him are two interesting takes, in one hand, he’s in pain and confused and Sarmenti is the only one who he recognizes to give him comfort but on the other hand, I’d understand why he wouldn’t want him to see him that way, he’s in a pretty bad shape...Well, up to you!

#[ask and be awnsered]#on a little note on the arrhythmia i think i mentioned more than once that cuddling and touch can aid some leprosy symptoms and thats where #im coming from. you know when babies are born and theyre placed on the chest of a parent? with direct skin-to-skin touch? its because #skin-to-skin stimulates the vagus nerves which controls breathing and heart beat. babies dont know how to manage at first so they need that #initial touch to be taught. its why hugs decrease stress and anxiety. you are pretty much designed to be held to heal sometimes #there are some maneuvers that will put you in positions to get the same results if you are alone that work just as well though

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