Kharfun Syndrome — an Invented Disease

Ever invented a disease?

I did, for my science fiction.

It’s called Kharfun Syndrome, and it plays a large role in the history of the Confederation. It first arose among Humans, for whom it was a flu-like but usually survivable disease. Many children got it, developed immunity, and went on to lead normal lives. But it became endemic in the Human population.

The early symptoms are mild – aches and pains, some muscle twitches – and that was as far as it got with a good functioning immune system. For those whose immune systems could not handle it, the virus gradually attacked the peripheral motor nerves, leading to violent muscle cramps which was followed by paralysis, and eventual death from respiratory paralysis. The peripheral sensory nerves were also involved during the active phase, with pain spreading inward from the fingers and toes.

The Human immune system, which is basically chemical in nature, could handle the virus. I’m not going to go into the full immune system here, and in fact there’s a lot we don’t know about it. But there are times when it goes wrong and attacks something it shouldn’t. Like the Islets of Langerhans in my pancreas (which is why I have type 1 diabetes) or the myelin sheaths of my sister’s nerves (Multiple Sclerosis.) Perhaps because of this the R’il’nai, who have a suite of esper abilities and could actually perceive bacteria and viruses and remove them without even being consciously aware of the process, developed an immune system based on esper, and the old-chemical-based system, while still present, became very inefficient.

The problem with Kharfun was that the virus causing it had evolved an ability to hide from esper perception.

As a result, Kharfun was originally 100% lethal to those whose immune systems relied on esper – all pure R’il’nai, and most of the hybrids with a large fraction of active R’il’nian genes. A method of reactivating the old, chemical-based immune system was developed after the disease spread from Humans to R’il’nai, but by that time a large fraction of the R’il’nai had died.

The disease had another effect on the R’il’nai – it reduced their already low fertility. They didn’t have a high birth rate to start with – R’il’nian females were fertile for a few hours a century. (They were usually receptive, but not fertile.) And the immunization had the same effect as the disease on fertility.

So 10,000 years after the initial epidemic, the R’il’nai are nearly extinct. This was the premise behind Homecoming (where Kharfun Syndrome plays a major role) and the society that led to Tourist Trap and the trilogy I’m working on.

Diabetes and Blood Sugar

Blood glucose.

It’s something I have to worry about, as does every diabetic. Too much glucose in the blood, and the circulatory system is affected. This in turn can lead to problems with eyes, kidneys, feet, and the entire nervous system, not to mention cardiovascular problems. Diabetes is one of the leading causes of blindness, kidney failure, foot and leg amputations, heart attacks, stroke—in short, high blood sugar can kill you. Not rapidly, but the long tem effects of uncontrolled high blood sugar (hyperglycemia) are all too often lethal.

If your body starts breaking down fats and proteins for energy, which can happen if insulin levels in your blood drop too low, death can come in a few days, from ketoacidosis.

Low blood sugar can be just as much of a problem, and can kill you much faster. Your brain runs on glucose, so low blood sugar (hypoglycemia) affects the brain. It can kill you much faster than high blood sugar. Generally you can feel it coming on, but this awareness tends to fade with time—a condition called hypoglycemia unawareness.

A lot of people with diabetes wind up in emergency rooms because they simply pass out from low blood sugar, without warning. Some never wake up.

If you don’t have diabetes, you don’t have to think about this. When your blood sugar rises, your pancreas pumps out a hormone called insulin, which helps the cells of your body to use glucose, either for energy or in storage as fat. When it falls, your liver releases stored glucose to the blood. As a result, your blood sugar fluctuates only slightly, and you don’t really have to think about it.

For those of us with type 1 diabetes, the pancreas no longer manufactures insulin. For some of us, the liver no longer dumps glucose into our system when needed, either. Since we have to inject insulin (or have a pump deliver it) too much insulin, too little food, too much exercise or some unknown effect can make our blood sugar plummet. The treatment is sugar. Straight glucose is fastest, but any carbohydrate will do.

In Homecoming, the R’il’nai and R’il’noids have a similar problem. Esper work means using the brain—hard—and the brain runs on glucose. The liver can only dump a limited amount of sugar into the blood, and then it runs out of stored glucose. Too much esper work without readily available carbohydrates can cause low blood sugar, which they call “esper shock.”

When Roi is leaning to use his esper talents, one of the first things he has to learn is that he must eat while he is using those abilities, whether or not he feels hungry. How he feels in esper shock is based very much on my own experience and that of others with diabetes.

When I was first diagnosed, I had a number of symptoms—sweating, shaking, lips tingling. Others may get very aggressive, fight someone who is trying to get them to eat, or just not act like themselves. Still others quietly pass out. Right now, my most reliable symptom is a kind of flare in my visual field that blurs my vision, along with a feeling of weakness. I’d still have some real problems without a blood glucose meter (which requires a blood sample) and a continuous glucose monitor. I still wonder at how I got through the first years, before meters, let alone continuous monitors, were available

Now if they’d just make the alarm on the CGM loud enough to wake me up at night ….

Cataract Surgery Complications

Sometimes I wish Roi and his Healing ability were real, rather than a creation of my mind. Still, ordinary doctors can do quite a lot.

This week, it was complications of cataract surgery. I had the lens replaced in my left eye over a year ago, with stunning results. A few days after the surgery, distant vision in my left eye was back very close to 20/20, though I still needed glasses to read. I’m getting to the point where my arms just aren’t long enough, but my overall vision was wonderful.

Then, so slowly that I was hardly aware of it, my vision began to fog up again.

I found it harder and harder to read. First, words on paper. I had to use a magnifying glass to read the phone book, but then ordinary type in books became more and more difficult. The computer screen was still readable, but more and more often I was having to zoom the text and set things I was writing to half again normal size. When I started having problems reading my insulin pump and glucose meter, I spoke to my eye doctor.

I’ve had problems with diabetic retinopathy for almost twenty years. The treatment for that is what is called pan-retinal coagulation. The outer part of the retina is killed with pinpoint burns from a laser. Effectively, the periphery of the retina—which gives peripheral vision and low-light vision—is sacrificed to save the inner part, which gives sharp focus and color vision. I’ve had lots of experience with that kind of laser treatment. It’s somewhat painful and vision afterward is blurry and pink-tinged for a while. (The laser is green.)

What I had now was posterior capsule opacity. The eye doctor explained that the laser was less intense than what I was used to, though from my point of view the procedure was much the same—eye dilated, a lens inserted in my eye, and several minutes of holding my head motionless against a frame while I fixed the gaze of my other eye on a small target light.

I could hear the clicks as the doctor used the laser to cut a small hole in the thickened capsule, but I could not feel it. After I was released from the chair, my vision was blurry and pink-tinged, as I expected. What I did not expect was that by the time I got home, about an hour later, I was able to see much better than I could only that morning.

Today, forty hours after surgery, my vision is bright and clear, and if I understand correctly what the surgery did, it should stay that way. Yes, the Healing ability of a few of my characters would be nice—but medicine today can do some wonderful things—if you can afford it.

Psi and Morality

What happens when loyalties and responsibilities conflict? What is the moral thing to do?

I’ve been exploring morality to some extent in my writing. I won’t say I have the answers—there really aren’t any. But here’s an excerpt from a story set years after Homecoming was over:

“My folks hadn’t been able to teach me the morality of using my esper talents–rules don’t arise about things that are assumed not to exist.  But they had ingrained some general principles into the fiber of my being, and those general principles worked quite well with what Roi had taught me and, more recently, with what I had found in the files my mother had left behind.  Put yourself in the other person’s shoes.  Remember that ‘human’ is not just you and your relatives, or those who look like you, or who share common beliefs.  Ask yourself, ‘what would life be like if everyone behaved this way?’

“It wasn’t as easy as rules-based, black and white morality, because it required thinking.  And there had been times, both home on Earth and here on Central, when the accepted morality was immoral by the principles I believed in.  Slavery as it was practiced here on Central, for instance.  Did I even have the moral right to walk away, if I could really stop it?”

What widely accepted moral rules might be immoral in a different society or environment? Or even in our own, if looked at closely?

Accelerated healing mode (Homecoming Glossary)

ACCELERATED HEALING MODE: Under normal circumstances, the body reacts against rapidly dividing cells. A Healer can temporarily suppress this reaction, allowing healing to take place much faster than normal. However, this state is not normal and can lead to cancer if not reversed within a few days.

Tack-healing (Homecoming Glossary)

TACK-HEALING: #scifi In Healing broken bones, the growth of calcification tends to be much slower than aligning the bone fragments and forcing rapid growth of cartilage. The most common way of Healing such injuries is to use Healing to align bone fragments  and accelerate cartilage growth, known as tack-healing because the bone, while “mended,” has only a fraction of normal strength. The patient is then instructed to avoid putting excessive stress on the damaged bone while calcification is occurring.

CounterShock (Homecoming Glossary)

COUNTERSHOCK: #scifi a medication that suppresses shock symptoms, but by itself has no pain-relieving properties.

Healing (Homecoming Glossary)

HEALING: A rare talent, involving both empathic and esper abilities. A Healer is capable of perceiving and correcting physical injuries and many illnesses (Kharfun syndrome is a rare exception) though it is unable to correct genetic errors.

Isolation Suit (Homecoming Glossary)

ISOLATION SUIT:#scifi  A suit, rather like a space suit, designed for complete biological isolation. Isolation suits are completely self-contained, carrying their own air and temperature control systems. Even with levitation circuits to take some of the weight, they are very uncomfortable to work in.

Esper Shock (Homecoming Glossary)

ESPER SHOCK: Intensive use of esper talents can run blood sugar down to dangerously low levels. The resulting hypoglycemia is called esper shock. Any source of rapidly absorbed sugar will counter it, but honey is widely used. For lasting treatment, the carbohydrate is normally followed with protein. Virtually identical to insulin shock, with similar symptoms and treatment.