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    Hi, would anyone be able to take a few minutes to help me work out what diagnosis would fit the main character of my story?

    At the moment she is diagnosed with X at a point where it has gone beyond the possibility of treatment for anything other than pain and/or prolonging life. She uses black market medicine to treat it and/or medicate the pain. She remains physically active and appears relatively okay up until the point she dies. She dies within months of diagnosis - preferably 6-8. Does anything fit this and if so, how?

    It can't be too obscure otherwise the nature of the illness will take over the story.

    Thank you for your time.
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    Pancreatic cancer? But I haven't got into med school yet, so this could be a poor suggestion. You mentioned 'black market medicines', but the heroine's health between diagnosis and death would depend in part on whether she also undergoes conventional treatment such as chemotherapy. Chemo could be debilitating, but there are valid reasons why she might refuse that option (quality of life, pregnancy even?).
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    Small cell lung cancer could possibly fit the bill.
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    I was thinking about trying to avoid the cancer route because she absolutely cannot undergo chemotherapy. It does seem, however, that it's the best fit. Would an untreated and incurable brain tumour be kept at bay sufficiently with a combination of steroids, morphine and anti-emetics? I understand her 'end' could then be to become gradually more and more disorientated until she finally slipped into unconsciousness. The difficulty being that I need that to be sudden - from high activity to suddenly collapsing. It's difficult to understand without any medical knowledge so I really appreciate your help.
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    (Original post by galvaniser)
    I was thinking about trying to avoid the cancer route because she absolutely cannot undergo chemotherapy. It does seem, however, that it's the best fit. Would an untreated and incurable brain tumour be kept at bay sufficiently with a combination of steroids, morphine and anti-emetics?
    Possibly, but you might expect what are called 'focal neurological signs' in which the tumour impinges upon nearby structures of the brain resulting in discrete packages of symptoms like weakness in a limb/down one side of the body or trouble speaking, etc. The list is exhaustive. Could also get more generalised symptoms like seizures.

    I understand her 'end' could then be to become gradually more and more disorientated until she finally slipped into unconsciousness. The difficulty being that I need that to be sudden - from high activity to suddenly collapsing. It's difficult to understand without any medical knowledge so I really appreciate your help.
    It's unlikely that someone with a brain tumour would just suddenly collapse and die. That could be more reminiscent of a large cerebral aneurysm though.
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    Presumably this is a youngish character?

    OP I think you may be asking for the impossible. You want:

    - Common/well-known illness

    - Does not prevent activity / no effect on functioning
    - Yet she requires black market drugs to manage symptoms? I can't imagine someone not being impaired by that. And why can't she obtain these legally if they are needed legitimately?

    - Prognosis 6-8 months (so quite specific)
    - Medics can do nothing to save her
    - YET, mechanism is sudden (eg: a single devastating event) without degeneration significant enough to cause impairment. How is this predictable enough to make the specific prognosis? Particularly as it is predictable (to give the prognosis), why isn't it preventable (eg: pacemaker, surgery, monitoring devices)? And what symptoms does it cause which require the black market drugs?


    EDIT: A heart condition might fit the bill of terminal (without transplant) and sudden death (some kind of arrhythmia) and they can affect young people - but the problem is I can't imagine her activity not being affected by a serious heart condition. And arrhythmia is fairly predictable so why wouldn't she have a pacemaker to prevent it? Maybe her pacemaker fails? And illegal drugs would be more likely to make her condition worse. Maybe she is using some kind of "booster" drugs to overcome fatigue associated with heart problem?
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    (Original post by Pigling)
    - Prognosis 6-8 months (so quite specific)
    - Medics can do nothing to save her
    - YET, mechanism is sudden (eg: a single devastating event) without degeneration significant enough to cause impairment. How is this predictable enough to make the specific prognosis? Particularly as it is predictable (to give the prognosis), why isn't it preventable (eg: pacemaker, surgery, monitoring devices)? And what symptoms does it cause which require the black market drugs?
    This, OP.

    It's difficult to contrive something that fits these criteria. Usually things that kill suddenly don't alert themselves with symptoms etc. before they kill. So patients with wouldn't know something was wrong and thus wouldn't be able to go in search of illegal remedies.

    EDIT: or if they did alert themselves, there'd usually be some kind of attempt to thwart it.

    If something's fatal and presents with symptoms c. half a year away from death, it's usually something with a distinct decline whereby symptoms get worse and the patient becomes more incapacitated.


    EDIT: A heart condition might fit the bill of terminal (without transplant) and sudden death (some kind of arrhythmia) and they can affect young people - but the problem is I can't imagine her activity not being affected by a serious heart condition. And illegal drugs would be more likely to make her condition worse. Maybe she is using some kind of "booster" drugs to overcome fatigue associated with heart problem?
    Yeah, long QT syndrome could also result in sudden death.
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    Maybe she has a bleed or thrombotic event associated with a terminal disease?

    Tbh the problem is that I just can't think of a disease that is incurabe and progressive so that death within a year is assured, yet the patient is very active/not impaired in anyway, but they have severe pain, which for some reason isn't medically treated so they have to seek black market drugs, and then they die of a sudden event before any real symptoms (other than the random pain) occur. Just doesn't happen. It's very contrived.

    At least maybe give her a second condition which causes the pain/drug seeking?

    Even then you're asking that her doctors know sudden death will occur (and how do they know this?), but can do nothing to prevent it. It's the chronic/progressive (and therefore symptomatic) stuff which is generally non-preventable.
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    Fibrodysplasia ossificans progressiva.
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    (Original post by Kinkerz)
    This, OP.
    It's difficult to contrive something that fits these criteria. Usually things that kill suddenly don't alert themselves with symptoms etc. before they kill. So patients with wouldn't know something was wrong and thus wouldn't be able to go in search of illegal remedies.
    If somethings fatal and presents with symptoms c. half a year away from death, it's usually something with a distinct decline whereby symptoms get worse and the patient becomes more incapacitated.
    Yeah, long QT syndrome could also result in sudden death.
    Bold bit is true if we only consider one condition. But what if the character has a terminal condition that is only discovered by luck, e.g., routine tests looking for something else.
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    (Original post by Pastaferian)
    Bold bit is true if we only consider one condition. But what if the character has a terminal condition that is only discovered by luck, e.g., routine tests looking for something else.
    I can't think of many terminal conditions that kill very suddenly after a 6-8 month period without incapacitation.
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    I may have thought of one!

    Highly vascular tumour/growth (hemangioma?) in the brain.

    Inoperable due to complex brain structures/ inaccessible (although if it is fatal this is the biggest problem as I imagine the surgical risk would be worth it - maybe the character doesn't want to risk brain damage, personality change etc?). Maybe the vascular abnormality is just too large.

    Identified after imaging for persistent headaches (accounting for difficult to manage pain?) or other mild (without significant disability) but persistent or red flag neuro symptoms (vomiting, visual field loss)

    Terminal because significant fatal bleeding is very likely / inevitable / time bomb.

    Sudden death by fatal haemorrhage.


    EDIT: Unfortunately for your brief this would be extremely rare/weird/freakish. Maybe the character has Von Hippel Lindau :teehee: Another problem is that even were she to have an inoperable hemangioma, she'd be offered radiotherapy to shrink the tumour, you'd have to look up how much that would interfere in her life.
    If she had VHL having multiple tumours and thus a poor prognosis would be more plausible. She'd probably have to have a history of surgery with the tumour(s) growing back for surgery to not be considered a good option.
    Also having looked it up spontaneous severe/fatal haemorrhage is actually rare even with these tumours, so it would be more a case of "we can't stop it growing back it may/will kill you eventually, there is a tiny chance you will die suddenly from haemorrhage". The timebomb inevitable haemorrhage aspect just doesn't really work.
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    Thanks everyone - you're giving me a lot to think about. In answer to some questions that have been raised...

    I have her as early-mid 30s.
    She is diagnosed whilst having an MOT, effectively.
    She knows she is going to die and tries to prop herself up for as long as possible to burn out quickly.
    Regardless of the chances it may offer, advanced medical options are not available to her.
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    I would say AML??

    At that age the prognosis is poor, some people don't realise they have it as the symptoms can be mistaken for other problems. Death is often very quick, especially without any treatment, such as transfusions, BMT etc and more often than not, at that age, treatment is often palliative.
 
 
 
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