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covid-safer-hotties · 27 days ago

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By Stephani Sutherland

Gentle nasal spray vaccines against COVID, the flu and RSV are coming. They may work better than shots in the arm

Alyson Velasquez hates needles. She never liked getting shots as a kid, and her anxiety only grew as she got older. “It really ballooned in my teens and early 20s,” she says. “It became a full-blown phobia.” She would panic at the sight of a needle being brought into an exam room; more than once she passed out. Velasquez says that she took an antianxiety medication before one appointment yet still ran around the room screaming inconsolably “like I was a small child; I was 22.” After that episode Velasquez, now a 34-year-old financial planner in southern California, quit needles completely. “No vaccinations, no bloodwork. For all of my 20s it was a no-go for me,” she says.

Then COVID showed up. “It finally hit a point where it wasn’t just about me,” Velasquez says. “It felt so selfish not to do this for the greater public health and the safety of our global community.” So she got vaccinated against the SARS-CoV-2 virus in 2021, although she had to sit on her husband’s lap while he held her arms. “It was a spectacle. The poor guy at CVS ... he did ask me, ‘Are you sure you want to do this?’” She very much did. “I’m very pro-vaccine. I am a rational human. I understand the necessity of [getting] them,” she insists. But today she still struggles with each injection.

Those struggles would end, however, if all her future vaccinations could be delivered by a nasal spray. “Oh, my God, amazing!” Velasquez says.

The amazing appears to be well on its way. Vaccines delivered through the nose are now being tested for several diseases. In the U.S., early clinical trials are showing success. Two of these vaccines have generated multiple immune system responses against the COVID-causing virus in people who received them through a puff up the nose; earlier this year their makers received nearly $20 million from Project NextGen, the Biden-Harris administration’s COVID medical initiative. Researchers are optimistic that a nasal spray delivering a COVID vaccine could be ready for the U.S. as soon as 2027. Although recent efforts have focused on inoculations against SARS-CoV-2, nasal vaccines could also protect us against the flu, respiratory syncytial virus (RSV), and more.

A few nasal vaccines have been introduced in the past, but they’ve been beset by problems. The flu inoculation FluMist has not gained popularity because of debates about its effectiveness, and a different vaccine was pulled from the market decades ago because some people had serious side effects. In China and India, nasal vaccines for COVID have been approved because those countries prioritized their development during the pandemic, whereas the U.S. and other wealthy nations opted to stick with arm injections. But this new crop of vaccines takes advantage of technology that produces stronger immune responses and is safer than preparations used in the past.

In fact, immunologists say these spritzes up the nose—or inhaled puffs through the mouth—can provide faster, stronger protection against respiratory viruses than a shot in the arm. That is because the new vaccines activate a branch of the immune system that has evolved for robust, rapid responses against airborne germs. “It may be more likely to really prevent infection from getting established,” says Fiona Smaill, an infectious disease researcher at McMaster University in Ontario. Such inoculations may also help reduce the enormous inequities in vaccine access revealed by the pandemic. These formulations should be cheaper and easier to transport to poor regions than current shots.

But nasal vaccines still face technical hurdles, such as how best to deliver them into the body. And unlike injected vaccines, which scientists can measure immune responses to with blood tests alone, testing for immunity that starts in nose cells is more challenging. But researchers working in this field agree that despite the hurdles, nasal formulations are the next step in vaccine evolution.

Traditional vaccines injected through the skin and into an arm muscle provide excellent protection against viruses. They coax immune cells into making widely circulated antibodies—special proteins that recognize specific structural features on viruses or other invading pathogens, glom on to them and mark them for destruction. Other immune cells retain a “memory” of that pathogen for future encounters.

Intramuscular injection vaccines are good at preventing a disease from spreading, but they do not stop the initial infection. A nasal spray does a much better job. That’s because sprays are aimed directly at the spot where many viruses first enter the body: the nose and the tissue that lines it, called the mucosa.

Mucosa makes up much of our bodies’ internal surfaces, stretching from the nose, mouth and throat down the respiratory tract to the lungs, through the gastrointestinal tract to the anus, and into the urogenital tract. Mucosa is where our bodies encounter the vast majority of pathogenic threats, Smaill says, be it flu, COVID, or bacterial infections that attack the gut. This tough, triple-layered tissue is specialized to fight off invaders with its thick coating of secretory goo—mucus—and with a cadre of resident immune cells waiting to attack. “Mucosa is really the first line of defense against any infection we’re exposed to,” Smaill says.

Mucosal immunity not only prepares the immune system for the fight where it occurs but also offers three different types of protection—at least one more than a shot does. Nasal vaccines and shots both mobilize immune messenger cells, which gather the interlopers’ proteins and display them on their surfaces. These cells head to the lymph nodes, where they show off their captured prize to B and T cells, which are members of another part of the immune system called the adaptive arm. B cells, in turn, produce antibodies, molecules that home in on the foreign proteins and flag their owners—the invading microbes—for destruction. Killer T cells directly attack infected cells, eliminating them and the microbes inside. This provides broad protection, but it takes time, during which the virus continues to replicate and spread.

That’s why a second type of protection, offered only by the mucosal tissue, is so important. The mucosa holds cells of the innate immune system, which are the body’s “first responders.” Some of these cells, called macrophages, recognize invasive microbes as foreign and swallow them up. They also trigger inflammation—an alarm sounded to recruit more immune cells.

Another part of this localized response is called tissue-resident immunity. These cells don’t have to detect telltale signs of a pathogen and make a long journey to the infected tissue. They are more like a Special Forces unit dropped behind enemy lines where a skirmish is occurring rather than waiting for the proverbial cavalry to arrive. This localized reaction can be quite potent. Its activation is notoriously difficult to demonstrate, however, so historically it’s been hard for vaccine makers to show they’ve hit the mark. But it turns out that one type of antibody, called IgA, is a good indicator of mucosal immunity because IgAs tend to predominate in the mucosa rather than other parts of the body. In an early trial of CoviLiv, a nasal COVID vaccine produced by Codagenix, about half of participants had detectable IgA responses within several weeks after receiving two doses. That trial also showed the vaccine was safe and led to NextGen funding for a larger trial of the vaccine’s efficacy.

It’s possible an inhaled vaccine may provide yet one more layer of protection, called trained innate immunity. This reaction is a bit of a mystery: although immunologists know it exists and appears also to be produced by intramuscular injections, they can’t quite explain how it works. Immune cells associated with trained innate immunity seem to have memorylike responses, reacting quickly against subsequent infections. They also have been found to respond against pathogens entirely unrelated to the intended vaccine target. Smaill and her colleagues found that when they immunized mice with an inhaled tuberculosis vaccine and then challenged them with pneumococcal bacteria, the mice were protected. In children, there is some evidence that a tuberculosis vaccine, in the arm, generates this type of broad response against other diseases.

Akiko Iwasaki, an immunologist at Yale University who is working to develop a nasal vaccination for COVID, sees two major potential benefits to nasal immunity in addition to better, faster, more localized protection. First, attacking the virus in the nose could prevent the disease from being transmitted to others by reducing the amount of virus that people breathe out. And second, Iwasaki says, the spray may limit how deeply the infection moves into the body, so “we believe that it will also prevent long COVID.” That debilitating postinfection condition, sometimes marked by signs of entrenched viral particles, disables people with extreme fatigue, chronic pain, a variety of cognitive difficulties, and other symptoms.

Making a new vaccine is hard, regardless of how you administer it. It needs to raise an immune response that’s strong enough to protect against future invasions but not so strong that the components of that response—such as inflammation and fever—harm the host.

The lining of the nose puts up its own barriers—literal, physical ones. Because the nasal mucosa is exposed to so many irritants from the air, ranging from pet hair to pollen, the nose has multiple lines of defense against invading pathogens. Nostril hair, mucus, and features called cilia that sweep the nasal surface all aim to trap small foreign objects before they can get deeper into the body—and that includes tiny droplets of vaccine.

And lots of small foreign particles—often harmless—still make it through those defenses. So the nose has developed a way to become less reactive to harmless objects. This dampened reactivity is called immunological tolerance, and it may be the biggest hurdle to successful development of a nasal vaccine. When foreign particles show up in the bloodstream, a space that is ostensibly sterile, immune cells immediately recognize them as invaders. But mucosal surfaces are constantly bombarded by both pathogens and harmless materials. The immune system uses tolerance—a complex series of decisions carried out by specialized cells—to determine whether a substance is harmful. “This is very important because we can’t have our lungs or gastrointestinal tract always responding to nonharmful foreign entities that they encounter,” says Yale infectious disease researcher Benjamin Goldman-Israelow. For example, inflammation in the lungs would make it hard to breathe; in the gut, it would prevent the absorption of water and nutrients.

These barriers may hamper the effectiveness of a nasal flu vaccine that’s been around for a while, called FluMist in the U.S. and Fluenz in Europe. The inoculation is safe, says infectious disease scientist Michael Diamond of Washington University in St. Louis, but it faces a similar problem as do injected flu vaccines: it isn’t very effective at warding off new seasonal flu strains. This might be because flu strains are so common, and people are frequently infected by the time they are adults. Their immune systems are already primed to recognize and destroy familiar flu particles. FluMist is built from a live flu virus, so immune cells probably treat the vaccine as an invader and demolish it as soon as it shows up in the nose, before it has a chance to do any good. This preexisting immunity isn’t such an issue in children, who are less likely to have had multiple flu infections. Nasal flu vaccines are routinely used to inoculate kids in Europe.

In other vaccines, researchers often use adjuvants, special agents that attract the attention of immune cells, to boost a response. Some nasal vaccines use adjuvants to overcome tolerance, but in the nose, adjuvants can pose unique dangers. In at least one case, a nasal adjuvant led to disastrous consequences. An intranasal vaccine for influenza, licensed in Switzerland for the 2000–2001 season, used a toxin isolated from Escherichia coli bacteria as an adjuvant to provoke a reaction to the inactivated virus. No serious side effects were reported during the trial period, but once the vaccine was released, Swiss officials saw a concerning uptick in cases of Bell’s palsy, a disease that causes weakness or paralysis of the facial muscles, often leading to a drooping or disfigured face. Researchers at the University of Zurich estimated that the adjuvanted flu vaccine had increased the risk of contracting Bell’s palsy by about 20 times, and the vaccine was discontinued. “We need to be cautious about using adjuvants like that from known pathogens,” says pharmaceutical formulations scientist Vicky Kett of Queen’s University Belfast in Northern Ireland.

To get around the challenges posed by the nose, some researchers are exploring vaccines inhaled through the mouth. Smaill is working on one of them. She and her McMaster colleagues aerosolized their vaccine for COVID into a fine mist delivered by a nebulizer, from which it rapidly reaches the lungs. Experiments in mice have shown promising results, with mucosal immunity established after administration of the vaccine.

Another vaccine strategy is to use a harmless virus to carry viral genes or proteins. Researchers at the Icahn School of Medicine at Mount Sinai in New York City selected a bird pathogen, Newcastle disease virus (NDV). “It’s naturally a respiratory pathogen,” so it infects nasal cells, says Michael Egan, CEO and chief scientific officer of CastleVax, a company that formed to develop the NDV vaccine for COVID. A small early clinical trial showed the CastleVax vaccine was safe and caused robust immune responses in people. “Those results were very promising,” Egan says. People who received the vaccine also produced antibodies that indicated multitiered mucosal immunity, not simply the adaptive immunity from a shot in the arm.

Following that trial, the CastleVax project received NextGen funding, and results from a trial of 10,000 people are expected in 2026. Half of those people will receive a messenger RNA (mRNA) injection, and half will get the new NDV nasal spray. The data should show whether the new nasal vaccine can do a better job of preventing infection than the mRNA injections. Egan has high hopes. “We’re expecting to see a lot fewer breakthrough infections in people who got the vaccine up the nose by virtue of having those mucosal immune responses,” he says.

Florian Krammer, one of the Mount Sinai researchers behind the vaccine, engineered NDV particles to display a stabilized version of the spike protein that’s so prominent in SARS-CoV-2. “You end up with a particle that’s covered with spike,” he says. Spike protein in the bloodstream can raise an immune response. But the NDV vaccine works in another way, too. The virus particle can also get into cells, where it can replicate enough times to cause virus particles to emerge from the cells, provoking another immune reaction. Before moving into human trials, however, researchers had to complete clinical trials to establish that the Newcastle virus is truly harmless because the nose is close to the central nervous system—it has neurons that connect to the olfactory bulb, which is part of the brain. Those trials confirmed that it is safe for this use.

Nasal sprays aim directly at the spot where most viruses first enter the body: the nose. This type of caution is one reason a COVID nasal vaccine approved in India hasn’t been adopted by the U.S. or other countries. The inoculation, called iNCOVACC, uses a harmless simian adenovirus to carry the spike protein into the airway. The research originated in the laboratories of Diamond and some of his colleagues at Washington University at the start of the pandemic, when they tested the formulation on rodents and nonhuman primates. “The preclinical data were outstanding,” Diamond says. Around the time he and his colleagues published initial animal results in Cell in 2020, Bharat Biotech in India licensed the idea from the university. In a 2023 phase 3 clinical trial in India, the nasal vaccine produced superior systemic immunity compared with a shot.

Diamond says American drug companies didn’t pursue this approach, because “they wanted to use known quantities,” such as the mRNA vaccines, which were already proving themselves in clinical trials in 2020. As the pandemic took hold, there was little appetite to develop nasal vaccine technology to stimulate mucosal immunity while the tried-and-true route of shots in the arm was available and working. But now, four years later, an inhaled vaccine using technology similar to iNCOVACC’s is being developed for approval in the U.S. by biotech company Ocugen. Both inhaled and nasal forms of the vaccine are set to undergo clinical trials as part of Project NextGen. These new vaccines are using classical vaccine methods based on the virus rather than using new, mRNA-based technology. The mRNA preparations were developed specifically for intramuscular injections and would have to be significantly modified.

Codagenix, which is developing CoviLiv, sidestepped the need for a new viral vector or an adjuvant by disabling a live SARS-CoV-2 virus. To make it safe, scientists engineered a version of the virus with 283 mutations, alterations to its genetic code that make it hard for the virus to replicate and harm the body. Without all these genetic changes, there would be a chance the virus could revert to a dangerous, pathogenic form. But with hundreds of key mutations, “statistically, it’s basically impossible that this will revert back to a live virus in the population,” says Johanna Kaufmann, who helped to develop the vaccine before leaving Codagenix for another company earlier this year.

Because most people on the planet have now been exposed to SARS-CoV-2—in the same way they’re regularly exposed to the flu—some nasal vaccines are being designed as boosters for a preexisting immune response that is starting to wane. For example, Yale researchers Iwasaki and Goldman-Israelow are pursuing a strategy in animals deemed “prime and spike.”

The idea is to start with a vaccine injection—the “prime” that stimulates adaptive immunity—then follow it a few weeks later with a nasal puff that “spikes” the system with more viral protein, leading to mucosal immunity. In a study published in 2022 in Science, Iwasaki and her colleagues reported that they primed rodents with the mRNA vaccine developed by Pfizer and BioNTech, the same shot so many of us have received. Two weeks later some of the mice received an intranasal puff of saline containing a fragment of the SARS-CoV-2 spike protein. Because the animals had some preexisting immunity from the shot, the researchers didn’t add any adjuvants to heighten the effects of the nasal puff. Two weeks later researchers detected stronger signs of mucosal immunity in mice that had received this treatment compared with mice that got only the shot.

“Not only can we establish tissue-resident memory T cells” to fight off the virus in the nose, Iwasaki says, but the prime-and-spike method also produces those vigorous IgA antibodies in the mucosal layer. “And that’s much more advantageous because we can prevent the virus from ever infecting the host,” she notes. The study suggests that this approach might also lessen the chances of transmitting the disease to others because of the lower overall viral load. Experiments in hamsters demonstrated that vaccinated animals shed less virus, and they were less likely to contract COVID from infected cage mates that had not been vaccinated themselves.

Although most of the new vaccine strategies are aimed at COVID, nasal vaccines for other diseases are already being planned. Kaufmann, formerly of Codagenix, says the company currently has clinical trials underway for nasal vaccines against flu and RSV. CastleVax’s Egan says “we have plans to address other pathogens” such as RSV and human metapneumovirus, another leading cause of respiratory disease in kids.

Vaccines that don’t need to be injected could clear many barriers to vaccine access worldwide. “We saw with COVID there was no vaccine equity,” Smaill says. Many people in low-income countries never received a shot; they are still going without one four years after the vaccines debuted.

In part, this inequity is a consequence of the high cost of delivering a vaccine that needs to stay frozen on a long journey from manufacturing facilities in wealthy countries. Some of the nasal sprays in development don’t need deep-cold storage, so they might be easier to store and transport. And a nasal spray or an inhaled puff would be much easier to administer than a shot. No health professional is required, so people could spray it into their noses or mouths at home.

For these reasons, needle-free delivery matters to the World Health Organization. The WHO is using the Codagenix nasal spray in its Solidarity Trial Vaccines program to improve vaccine equity. The CoviLiv spray is now in phase 3 clinical trials around the world as part of this effort. “The fact that the WHO was still interested in a primary vaccination trial in the geographies it’s passionate about—that’s indicative that there is still a gap,” Kaufmann says. CoviLiv was co-developed with the Serum Institute of India, the world’s largest maker of vaccines by dose. The partnership enabled production at the high volume required for Solidarity.

The CastleVax vaccine with the NDV vector provides another layer of equity because the facilities required to make it already exist in many low- and middle-income countries. “The cool thing is that NDV is a chicken virus, so it grows very well in embryonated eggs—that’s exactly the system used for making flu vaccines,” Krammer says. For example, for a clinical trial in Thailand, “we just shipped them the seed virus, and then they produced the vaccine and ran the clinical trials,” he says. Many countries around the world have similar facilities, so they will not need to depend on pharma companies based in richer places.

Even high-income countries face barriers to vaccination, although they may be more personal than systemic. For very many people, the needle itself is the problem. Extreme phobia such as Velasquez’s is uncommon, but many people have a general fear of needles that makes vaccinations stressful or even impossible for them. For about one in 10 people needle-related fear or pain is a barrier to vaccinations, says C. Meghan McMurtry, a psychologist at the University of Guelph in Ontario. Needle fear “is present in most young kids and in about half of adolescents. And 20 to 30 percent of adults have some level of fear.” A review of studies of children showed that “concern around pain and needle fear are barriers to vaccination in about 8 percent of the general population and about 18 percent in the vaccine-hesitant population,” McMurtry adds.

Some people are wary of injected vaccines even if they’re not afraid of needles, Kett says; they see injections as too invasive even if the needle doesn’t bother them. “We’re hopeful that something administered by the nasal route would be less likely to come across some of those issues,” Kett says.

In the U.S., however, sprays and puffs won’t be available until they are approved by the Food and Drug Administration, which requires clear evidence of disease protection. As Diamond points out, standards for such evidence are well established for injections, and vaccine makers can follow the rule book: regulations point to particular antibodies and specific ways to measure them with a simple blood test. But for nasal vaccines, Iwasaki says, “we don’t have a standard way to collect nasal mucus or measure antibody titers. All these practical issues have not been worked out.”

Iwasaki is also frustrated with a restriction by the U.S. Centers for Disease Control and Prevention that stops researchers from using existing COVID vaccines in basic research to develop new nasal sprays. The rule is a holdover from 2020, when COVID injections had just been developed and were in short supply; people had to wait to get vaccinated until they were eligible based on factors such as age and preexisting conditions. “That made sense back then, but those concerns are years old; things are different now,” Iwasaki says. “Now we have excess vaccine being thrown out, and we cannot even get access to the waste, the expired vaccine.”

Today scientists want to contrast the effectiveness of nasal formulations with injections already in use. “Those comparisons are really important for convincing the FDA that this is a worthy vaccine to pursue,” Iwasaki says. But the restriction has held up studies by her company, Xanadu, slowing down work. (The CDC did not respond to a request for comment.)

Despite the bureaucratic and scientific hurdles, the sheer number of nasal vaccines now in clinical trials encourages Iwasaki and other scientists pursuing the needle-free route. They say it seems like only a matter of time before getting vaccinated will be as simple as a spritz up the nose.

Velasquez, for one, can’t wait for that day to arrive. The circumstances that finally forced her to reckon with her fear of needles (a global pandemic, the prospect of parenthood and the numerous blood tests that accompanied her pregnancy) were so much bigger than her. If not for them, she might still be avoiding shots. “So having vaccines without needles—I would get every vaccine any doctor wanted me to get, ever. It would be a complete game changer for me.”

#vaccination #mask up #covid #pandemic #public health #wear a mask #covid 19 #wear a respirator #still coviding #coronavirus #sars cov 2 #get vaccinated #vaccinate your kids

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getphysicalexam · 1 year ago

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8GP5Jf0lcpE

#doctor and patient #head to toe assessment #physical exam #stethoscope #doctor roleplay #male body #cardio exam #health assessment #heart auscultation #auscultation #respiratory exam #cardiac examination #cardiovascular examination #cardio

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bufomancer · 3 months ago

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Foster rat Cheesecake (lighter colored rat with the white dot) has a URI so he and his buddies got to go to the vet today for cuddles an exam and get some meds. Luckily his buddies don’t have any respiratory concerns and it will hopefully stay that way.

#cheesecake #dobos torte #nemo #foster critters #ratblr

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oneshotnewbie · 9 months ago

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If you come back soon could I pretty please request an Amelia (greys) one shot where the reader is her girlfriend and is brought to the ER in critical condition as Jane Doe but as soon as Amelia sees her she’s hysterical and all she wants to is reasure and hold the readers hand! YOU WOULD MAKE MY QUARANTINE SO MUCH BETTER I LOVE YOUR WORKS SM

Authors note: So... um... I know I waited so long to post this request but... I HAVE MISSED IT IN MY INBOX FOR SO LONG AND WHEN I FOUND IT TWO DAYS AGO, I WROTE IT IMMEDIATELY! I am so sorry. I hope you're still out there somewhere recognizing your request and reading it ♥

ᕚ---ᕘ

The hustle and bustle of the emergency room echoed through the cold hallways as the double doors were pushed apart to make way for the ambulance crew and their critical patient. The vehicle's red and blue lights cast flickering shadows on the walls, while the howling sound of the approaching accident conveyed to hospital staff the urgency of the situation.

The paramedics, with serious faces and rustling uniforms, wheeled the gurney into the emergency room. An unknown woman lay on the stretcher, pale and motionless, only the shallow rise and fall of her chest showed any life. A white sheet covered her completely, and her blood-stained hair stuck damply to her forehead. The slow, monotonous beep of the portable monitor accompanied every breath.

Dr. Hunt, the emergency physician in charge, immediately rushed to the bed. His expression was professional, but the depth of his gaze betrayed some concern. The nurses and also Dr. Keppner rushed to help the team take over.

"What do we have?" Owen asked as he looked over the medical file one of the paramedics handed him. "Unknown female person, middle-aged, found unconscious in a park, presumably after an attack. Stabbed in the chest and abdomen. We cannot say any more. No identification and no indication of possible previous illnesses."

The paramedics quickly explained the course of events, how they found the patient and what first aid measures they had taken. The information was relayed with the precision of a well-trained team, but uncertainty about who the woman was and what had happened to her hung in the air.

While Hunt and Keppner began checking vital signs, the unknown woman was wheeled into an examination room. The nurses exchanged hand signals and quietly instructed each other on the next steps. The background noise is a chaotic orchestra of clanging instruments, murmuring conversations and the beeping of medical equipment.

April Keppner leaned over the patient and began a thorough examination. She checked the pupillary reaction, palpated the pulse and analyzed the respiratory rate. The monitors showed unstable readings and the two doctors' facial expressions hardened. A quick look between the two revealed that they were worried.

"We need a CT scan immediately," Owen said, turning to the nurses present. "I also want blood samples for a comprehensive analysis. Let the lab know it's urgent."

While preparations for further examinations were underway, the nurses and doctors tried to keep the unknown woman stable. An intravenous line was placed and fluids began flowing through her derm. The monitors continued to show jittery signals and the tension in the room increased.

"Call Dr. Shephard and Dr. Altmann. I want them here as quickly as possible!" He ordered as he continued to analyze the data on the screen. "And someone should inform the police. We have to find out who she is and what happened in order to prevent further damage."

The exam room was now in a coordinated state of emergency and in a room that was normally a place of rescue, the medical team battled uncertainty and a race against time to save a woman's life. He was abuzz as the neurosurgeon and cardiologist burst through the door almost simultaneously with quick steps. Their eyes were focused, the rubber of their Crocs squeaking in unison with the machines.

"Shephard, the patient is exhibiting unstable neurological signs. The CT scan and blood results are pending," she informed Hunt as he cleared the way for her to the bed.

Amelia nodded curtly and fully entered the room, closing the door behind her. A glance at the monitor and the papers on the tablet caused her eyes to flash briefly before she focused back on the patient. However, as she leaned over the lounger, she froze.

Her features slipped away, the slight smile on her lips fading as she realized who was in front of her. The woman on the lounger was none other than you. Hunt and Keppner stared at her as she noticed her reaction, not understanding why she didn't move forward with her work. "Amelia, we have a critical situation here. The patient's identity is unknown and her values are concerning. We urgently need your expertise!"

Amelia shook her head slightly, as if she could push reality away. Her heart raced as she double-checked that her eyes weren't playing tricks on her. "This is y/n. Y/n y/l/n. She's my girlfriend. Find her family, get them here!" A strangled sound escaped her throat and the world around her seemed to stand still for a moment as she processed the shock.

The emotional rollercoaster went through all the ups and downs, from worrying about you to the overwhelming need to stay in control. Her hands shook slightly as she reached for your lifeless and bloody hand.

"Y/n," Amelia whispered with a strangled sound in her voice and the two doctors and friends of the neurosurgeon were also dumbfounded, their breath catching in their throats. "What happened to you?"

Owen Hunt moved closer and tried to reassure her, while also conveying the urgency and explaining the neurological details. But Amelia only heard fragments. Her gaze was lost in your eyes, which were closed as if you were in a deep sleep.

"Amelia, I know it's hard. But we have to act immediately. The CT results are crucial and we have to find out what happened to her to prevent something worse. She could die!" April urged, concerned about her colleague's professionalism.

But Amelia couldn't let go. She ignored the two of them, her focus solely on you. The world outside the exam room seemed to fade as she held your hand tightly. "Y/n, you have to hold on. You can do this," she whispered in your ear, tears of despair welling up in her eyes. "You're strong, you know? We'll get through this together."

In her emotional despair, an internal struggle unfolded within Amelia. Her professional self fought against her personal connection to you. The shouts of other doctors and nurses became a muffled background noise as she refused to loosen her grip on your cold hand.

"Amelia," Owen Hunt spoke in a calm but firm voice. "We need you now. She needs you now. Let's find out what happened to her together.

A conflict between duty and personal pain raged within Amelia. Finally, she reluctantly gave in and removed her hand from yours. However, her gaze remained focused on you, and concern for you was reflected deep in her eyes. She struggled with fear for you as she prepared to resume her professional role as a neurosurgeon.

A deep breath flowed through her body and with a firm resolve she wiped the tears from her cheeks and turned her gaze to the surroundings. "Dr. Hunt, take her to the CT immediately. She's probably having a brain bleed." she spoke, her voice firm. The neurosurgical focus returned fully, analyzing the medical indicators.

The trauma surgeon nodded in agreement and began giving the necessary instructions, getting you up to the CT scanner. Amelia stayed at your side, letting go of your hand for a moment to oversee the diagnostic process.

The minutes that passed felt like hours. The results of the CT scan appeared on the screen, and Amelia scanned the images with a trained eye. She analyzed each region of the brain, looking for signs of bleeding, injury or other abnormalities. The intensity of her concentration was palpable, and the medical staff eagerly awaited her assessment.

"We have severe damage to the frontal lobe," Amelia explained, swallowing hard as she continued to study the images. "It looks like a severe traumatic brain injury. We need to operate immediately to relieve the pressure and prevent further damage."

The team immediately began preparing for the operation. The sterile atmosphere of the operating room seemed to embrace Amelia as her professional role took over. In her surgical uniform, surrounded by a team of experienced professionals, she struck her familiar Superman pose and focused on the procedure ahead.

During the operation, which lasted several hours, your girlfriend showed an impressive mix of calm and precision. Her hands worked in sync with the instruments as she gently treated the damaged tissue. Monitors in the operating room recorded progress, and the medical team closely followed their experienced leader's every move.

After what seemed like endless hours, but which passed like seconds, she finally closed the last stitches and the atmosphere relaxed slightly, but the uncertainty about the outcome of the operation weighed heavily on her.

Amelia let out a frustrated gasp before exiting the operating room, tearing off her gloves and hood. She immediately went to the waiting area to inform your siblings and parents. The tension in her chest eased as she saw the expectant looks of the people who were now her family and your sister immediately threw her arms around her.

"The operation is complete," Amelia began, trying to keep her voice steady as she also clung to your sister to keep her emotions at bay. "It was a complex brain injury for reasons still unknown, but I did everything I could. The next step now is to wait and hope she remains stable."

Your family breathed a sigh of relief as Amelia explained more details about the condition and cooperation with the police. Her words were reassuring to your sister, but she still felt the knot in her stomach. The outcome of the operation was uncertain, and there was no way of knowing whether you would ever wake up and be your old self again.

In the silence of the hospital hallway, as she left the waiting people behind, a moment of exhaustion overcame her. Her eyes wandered back to the exam room where she found you in. The image of you on the lounger didn't fade, but Amelia found comfort in the fact that she had saved you. Now things could only go uphill and she couldn't wait to look into your beautiful eyes again.

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roxiewyatthb · 5 months ago

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Cardiophile Turn On/Off

I got this from @/heartbinary who got it from @/torture-steth-repeat

I wanted to do it myself to not only have some boundaries but also so people can get to know me a tad bit better

💚 = Turn on

💔 = Turn off

🤍 = Neutral/Like it in a non-sexual way

Section 1: Cardiophilia basics

1. My heart being listened to: 💚

2. Listening to others' hearts: 💚

3. Fast heartbeats: 💚

4. Slow heartbeats: 🤍

5. Naturally irregular heartbeats: 💚

6. Deliberately irregular heartbeats: 💚

7. Heart via stethoscope: 💚

8. Heart via EKG: 💚

9. Heart via Doppler: 🤍

10. Heart via ultrasound: 💚

11. Carotid (throat) pulse: 💚

12. Femoral (groin) pulse: 🤍

13. Radial (wrist) pulse: 🤍

14. Chest/belly pulse: 💚🤍

15. Ear stething: 💚

Section 2: Dark Cardiophilia

1. Shocking a healthy heart: 💚

2. Pressure/crushing a healthy heart: 💚

3. Drowning + heart monitoring: 💚

4. Suffocation + heart monitoring: 💚

5. Choking + heart monitoring: 💚

6. Drugs used to affect the heart: 💚

7. Knifeplay + heart monitoring: 💚

8. Needle or injection into the heart: 💚

9. Gunplay (shooting the heart): 💚

10. Being dominated (in a cardiophilia way): 💚

11. Dominating someone else (in a cardiophilia way): 💚

12. Consensual non-consent (CNC) play: 🤍

13. Heart rips: 💔

14. Fucked into cardiac arrest: 💚

15. Heart being fucked: 🤍

16. Heart being licked or bitten: 🤍

17. Heart being eaten: 🤍

18. Hands squeezing the heart directly: 💚

19. 'Unhappy endings' (RIP) for dark cardiophilia: 💔

Section 3: Medfet/Resus

1. Blood pressure readings: 💔

2. Medical equipment: 🤍

3. Medical exam roleplay: 🤍

4. Resuscitation via CPR: 🤍

5. Resuscitation via defibrillator: 🤍

6. Resuscitation via AED: 🤍

7. Cardiac arrest: 💚

8. Respiratory arrest: 🤍

9. Sex and resus combined: 💔

10. 'Unhappy endings' (RIP) for resus: 💔

11. Anesthesia: 💔

12. Breathing masks: 🤍

Section 4: Graphic

1. Open heart surgery footage: 💚

2. Real animal hearts: 💔

3. Real human hearts outside the body: 💚

4. Real human hearts in autopsies: 🤍

Section 5: Adjacent Kinks

1. Gyno medical exams: 💔

2. Pregnancy/breeding: 🤍

3. Belly sounds: 💔

4. Cardiophilia + furry: 💚

5. Vampires: 🤍

6. Necrophliia: 💔

Section 6: 😏

1. Reading someone's bio before engaging with them: 💚

2. Asking about boundaries: 💚

3. Respecting those boundaries: 💚

4. Good spelling: 🤍

#i hope i did this right lmao #cardiophilia #cardiophile #roxie speaks #heartbeat kink #heartbeat #dark cardiophilia

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nickcprdefibs · 3 months ago

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Sebastian is at the doctor's office for a sports checkup. The doctor performs the usual heart exam both at rest and after some exercises, along with other checkups on the exam table.

Despite some respiratory issues, no major problems are found, so the doctor gives him the certificate.

Watch the preview here: https://youtu.be/adKrxSoZi1o

Full version $14.90

#heartbeat #sports #exercise #stethoscope #doctor #patient

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darl-ingfics · 2 months ago

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Sicktember Day 24: Tales from the Waiting Room

Fandom: ATEEZ

Sickie: Yeosang, Mingi (unspecified, general respiratory illness)

Caregiver(s): Mingi

Word Count: 1,259

Notes: COLLEGE AU!!!!!! ALSO! This fic was lifted from something I wrote for a different fandom years ago (never published) but DOES insinuate romantic relationships. The two characters in the fic are NOT the ones dating, and I don't specify who they ARE dating, but I kind of liked that element in the original piece, so I left it here, but super vague cause I'm not wholly comfortable speculating that kind of stuff. Is it out of the realm of possibility for me to write a romantic ship fic one day? No. But am I there yet? Also no.

The only thought that Yeosang had the energy to entertain as he did his best not to fall over on his way back to the house was wondering how he’d gotten out of bed that morning. He hadn’t slept very well, and if his calculations had been correct, he’d only logged about four hours of sleep. The sweatshirt he’d thrown on over top of a long-sleeved sweater wasn’t helping at all against the chills he was trying to ignore, and the miserable weather wasn’t helping either. His throat felt like he’d been swallowing pinecones for fun, he couldn’t breath through his nose, his head was pounding, and he hadn’t really eaten that day as the thought of actually eating the cereal he’d pushed around in his bowl that morning had made his stomach turn.

As much as he hated to say it, or think it, Yeosang had to admit to himself that he felt incredibly under the weather and probably shouldn’t have gone through the process of getting up at all. But unfortunately there had been a final to take, a genetics final, and feverish or not, he had to take that test. Thankfully, it was his last exam and he now had all the time in the world to sleep off whatever bug had infiltrated his system.

The rush of warm air that met him as he pushed open the door to the house felt like absolute heaven. After closing the door (and the frigid air) behind him, Yeosang paused, his back resting against the door, and he simply took a moment to breathe. Or at least he tried to breathe, but that didn’t seem like an actual possibility as the air got stuck in his throat and prompted a round of coughs that left him very out of breath. Well, that was worrisome.

“Who’s home?” a hoarse voice called from the living room.

“Yeosang,” he replied, frowning at the agonizing pain saying that one word induced. Not a moment later, Mingi appeared from around the corner, bundled up in all his winter wear.

“You sound like shit,” he stated plainly.

“You should talk,” Yeosang replied.

“Yeah, but I was sick yesterday and you didn’t look like a zombie this morning so…” Mingi argued plainly, knowing he’d won this argument. But his fighting words (docile as they were) disappeared in thin air as he asked, “Want to go to the clinic down the street with me? Yunho said they don’t suck. Not in those words. But that’s what I took away from it.”

“That would be nice,” Yeosang nodded, opening the door once again and following Mingi out to the car. “Want me to drive?”

“If you’re offering,” Mingi replied, stifling a cough in his fist. “I can drive home. We’ll call it even.”

“Okay,” Yeosang replied as they both slid into his car.

“At least the pharmacy is close,” Mingi commented, pulling his knees up to his chest in the passenger’s seat and resting his head on top of them. Yeosang wasn’t sure how he was able to make himself so compact in such a small space, but Mingi also looked so sick and sad that it made his heart melt a bit to see her like this. “And you won’t make fun of me like Wooyoung would.”

“You know he’s just kidding,” Yeosang replied softly as he backed out of the driveway. “He teases me all the time. And he knows you’ll fight back, so he takes it as a challenge.”

“Even when I’m sick and clearly weak and helpless and he has the obvious advantage?” the taller man asked, the words catching in his throat and causing his to cough again. Mingi pouted her lips at Yeosang as if to prove his point.

“Hey, this is natural selection. Survival of the fittest,” Yeosang replied, shrugging his shoulders innocently. As he pulled up to a stop sign, he gave her an apologetic smile. “Looks like Wooyoung’s the fittest.”

Mingi smacked his shoulder, feigning offense at his joke before laughing. Yeosang laughed back until it dissolved into painful coughing once again, and he allowed Mingi to do the rest of the talking until they’d reached the CVS. There was a very small line at the minute clinic, and the duo got their names on the list and were huddled together on the plastic waiting room chairs in no time.

“Dear god, do they have the AC on?” Mingi asked, wrapping his arms around himself and pulling one leg up onto the chair, knee to his chest.

“Maybe,” Yeosang replied, feeling chills prickling up and down his own arms, tingling through his spine.

“Want to cuddle?” Mingi asked plainly.

“Sure,” Yeosang agreed, sinking into Mingi’s side as the taller man wrapped an arm around him.

“You’re so warm,” Mingi moaned, snuggling as close to Yeosang as the chairs would let him. “Are you always this warm? Is it just the fever? Is it you or me?”

“I’ve been a science major for three years, and I honestly can’t think of any terminology to explain it to you right now,” Yeosang admitted weakly.

“That means you’re either brain dead after your test or much sicker than we think you are,” Mingi replied. “Or they’re just not teaching you anything and you’re doing all that homework for nothing.” Yeosang hummed, snuggling as deep as physics would allow into Mingi’s side. Mingi continued talking to him, a silly story about some of his classmates that Yeosang knew was just to keep the other man’s mind off of their current situation. But it also had the side of effect of putting Yeosang right to sleep as the deep vibrations of Mingi’s voice passed through their many points of physical contact, lulling Yeosang into peaceful unconsciousness.

He had no idea how long had passed when Mingi poked his shoulder. “Hey, babe. You awake?”

Yeosang shook his head, trying in vain to clear the haze away. “Um-hm,” he mumbled in response, his head falling back on Mingi’s shoulder, where fingers started running through his hair.

“Wake up, bud. It’s our turn.”

Yeosang roughly sat back from Mingi’s embrace, pouting slightly at his roommate. Mingi chuckled, standing up first and offering Yeosang his hand. The shorter man took is begrudgingly, trying to avoid the eyes of the way-too-smiley nurse leading them back into the exam room.

“Thanks for stopping in today. I mean, sorry that you had to, but glad you came to us,” the nurse said quickly. Yeosang had to assume they were new at this. At least the greeting people part. He had full faith in their medical abilities. Damn, this fever was messing with him.

“Glad you were so close,” Mingi replied, ever charming as he led Yeosang to sit on the exam table. His hands guided Yeosang’s shaky movements, and once the shorter man was situated, Mingi hopped up on the table next to him.

The nurses eyes moved between the two of them, a question he couldn’t ask apparent in his gaze. “How do you two know each other?”

“Just roommates. Along with my boyfriend, his boyfriend, and four other guys, romantic partners not confirmed,” Mingi replied plainly.

The nurse nodded. “Sounds like a party.”

“Oh, you should see us play monopoly,” Mingi practically purred, a cat like grin stretching on his face. Yeosang rolled his eyes, resisting the urge to smile. As long as Mingi’s banter got them in and out of here as fast as possible, with the strongest medication available, who was he to stop him?

#sicktember 2024 #sicktember #ateez sickfic #ateez sick #ateez fanfic #kpop sickfic #kpop fanfic #kpop sick #sickie yeosang #sickie mingi #caretaker mingi #darlingfics

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