Advanced Dragon Healing

Note: Although Thread no longer falls, it has been included in this text for reference material.

Advanced Wound Care

Any disruption of the hide, or surrounding body surfaces, is known as a wound. Most wounds are classified as being open, with a break in the hide through which ichor may escape. This, however, disrupts the normal impenetrable barrier to infection, as germs may enter via the route of injury.

How the wound is created determines the type of the wound and also influences the treatment given. Incision wounds are made by a clean cut from a sharp edge, such as a knife. There may be profuse ichoring because the edges of ichor vessels are cut straight across. Generally, this type of wound is rare in a dragon, and is usually the result of some surgery on the part of the dragonhealer. Lacerations are rough tears caused by crushing or ripping forces, generally from another object/dragon. Lacerations may ichor less profusely than clean cut wounds; though there is more tissue damage. Contamination risk from germs and subsequent risk of infection is high. These may happen during a mating flight when talons may shred the hide of an opponent. Abrasion wounds are superficial wounds in which the top layers of the hide are scraped off, leaving a raw tender area, and are caused predominantly by a sliding fall or a friction burn. They often contain foreign particles that may cause infection. In dragons these can occur from brushing against rock, bad landings on hard dirt, etc. Puncture wounds are caused by the entry of a sharp foreign body into the hide, such as stepping on a needlethorn. They are characterized by having a small site of entry but a deep track of internal damage. As dirt and germs can be carried far into the body risk of infection is high. Generally, because dragon hide is so thick, these injuries are extremely rare, but may occur in the frenzy of blooding with sharp bone fragments from the herdbeasts and wherries. Threadscore is similar to an incision wound in tissue damage, but with the complication of a burn. Depending on the resultant damage, threadscored wounds may ichor profusely or ooze slowly.

Several of these wound types can cause serious ichoring, and it is imperative that a dragonhealer learn to recognize the various types of ichoring from the various types of vessels. With arterial ichoring, the ichor is dark green and under pressure from the pumping hearts. Therefore, ichor is spurted from the wound in time with the heartbeats. A severed artery may produce a jet of ichor several feet high and can rapidly empty the circulatory system of ichor. These are extremely rare since arteries are found deep under a dragon hide, but may be encountered in wing injuries where the tissue is much thinner. With venous ichoring the ichor is a brighter green in coloration. It is under less pressure than arterial ichor, but since the vein walls are capable of great distention, ichor may pool. Thus, ichor from a severed major vein may gush profusely. Capillary ichoring can be characterized as oozing and occurs at the site of all wounds. Although capillary ichoring may at first be brisk, ichor loss is generally negligible. When the ichor vessels are severed or torn, their damaged ends constrict and retract in order to minimize ichor loss. At the same time, the ichor that escapes from damaged vessels begins to clot. However, the physical condition of the dragon will deteriorate exponentially to the amount of ichor lost. At first, the heartbeats will increase in tempo, the gradually the skin will grow gray, as the hearts divert ichor to the major organs. Eventually shock will become evident, which will be followed by the dragon becoming unconscious and life eventually failing.

One of the greatest dangers with any wound is that of infection. Wounds should always be cleansed with redwort, and care should be taken to remove all dirt and other foreign objects.

Assess the situation: If the dragon is in pain, then ask a Gold to 'dampen' the pain and still the movement. Involve the rider. Ask the rider for details of the injury. If this is the result of a mating flight, make sure you start handing the rider skins of wine. Take control of the situation, but never forget to ask a rider first for permission to approach their lifemate - big dragon, in pain, equals a dangerous combination.

Determination: What type of ichoring do you have? Is the ichor gushing, oozing, or spurting? Is this a slight, moderate or severe injury?

Treatment:

1. Clean wound with redwort.
2. Slather with numbweed. Remove any dirt, foreign articles etc.
3. If ichoring has not stopped, apply a pressure bandage to the wound. A pressure bandage is merely a pad of bandaging material that is applied over the wound and pressed tightly in place. If this soaks through, it should not be removed; instead, a second bandage should be applied on top of the first. In most cases, this will be enough to stop ichoring.
4. If ichoring is severe and does not respond to a pressure bandage, or if ichor is gushing/spurting from a wound, stronger measures are needed. Apply pressure to the vessel feeding blood to the area if possible. This may entail having an assistant physically clasp the vessel and stopping ichor from escaping in such large quantities. If not, quickly (time is of the essence here), use surgical clamps to restrict the flow/loss of ichor.
5. The vessel then needs to be sutured to the severed end as quickly as possible. The longer the tissue is without ichor the less healthy it will become. However, this is no excuse for rushing and making mistakes!

Sutures:
a. Do caution anyone that's distressed by the thought of stitches to look away.
b. Using a steel needle, and the treated thread (soaked in a redwort and hot wax solution), make small, neat stitches. Take care in making sure the edges of the wound are drawn together, but not tightly. Tight stitches will cause puckering of the surrounding hide, and may become impossible to remove. Always make as few stitches as possible but make sure the wound does not gape. You need this to be a barrier to infection.
c. First stitch in one side of the wound and then in the other with the same piece of thread.
d. Loop one end twice over the other and tighten, this will form a knot.
e. Clip the excess and start of the next stitch.
f. Apply more numbweed.

6. Remove the clamps slowly, check for any formation of ichor. You may have to clear some of the numbweed away with oil-soaked pads to see clearly.
7. Reapply numbweed.
8. Suture any wounded muscle together and then finally the hide.
9. Apply more numbweed

Recovery: For minor injuries usually a day or two is all that is required. Numbweed will help clot the ichor, and so the wound will heal quickly. For more moderate injuries, usually no more than a sevenday is required. Obviously, if the injury is in a place that would be exacerbated, such as under the straps, on the wingsails, they will need to rest longer. Severe wounds are likely to keep the dragon out of the air for several sevendays. It is important during this time to replace lost fluid by making sure the dragon drinks. If the amount of ichor lost is great, then a transfusion may become necessary. A wound that has been stitched needs to be kept moist to avoid further scarring. Stitches should be removed by a dragonhealer approximately a sevenday after they have been placed. Generally when the dragon begins to complain of itching, sufficient healing has taken place to allow the suture removal.

Removing Stitches from a Wound:
a. Cleanse the area with redwort and apply a light coat of numbweed.
b. Again, ask the rider to look away, if necessary.
c. Clip the threads with scissors, or cut them with a sharp knife, being careful not to cut the hide.
d. Using small tweezers, remove each of the threads from the hide.
e. Apply a light coat of numbweed over the punctures left by the threads, this will help to seal them.

It is important to keep wounds clean and protected from further injury. The rider should be cautioned about the signs of infection and urged to seek a dragohealer if they notice any of these signs:

Increasing pain and soreness.
Swelling, redness and a feeling of heat around the wound.
Pus within, or oozing from, the wound.
Faint trails leading away from the wound.
If the infection is advanced, signs of thirst, gray hide and lethargy.

Cardiovascular Complications

Dragons are warm 'blooded' even though their body temperature seems to be a little cooler than humans. This can be determined through their reactions to hot and cold temperatures. Their 'blood' is called ichor, and is dark green in color. Similar to blood, ichor is based on a metal element, but is in this case copper and not iron. Injuries, therefore, that release ichor will have a metallic smell associated with them.

Ichor circulates around the dragon in a continuous cycle, pumped by the rhythmic contraction/relaxation, or beat, of the heart muscles. The typical lub-dub of the heart is due to first the atria (upper heart chambers) filling with blood, and then the contraction of the atrium muscles filling the ventricles (lower heart chamber). This, however, is further complication in a dragon that has multiple hearts, and it takes a trained ear to identify an irregular beat in one heart. Since dragon carcasses are not readily available the exact number of the hearts is unknown. The reason for multiple hearts has never been discerned, but it is thought that this may be due to the effects of altitude and exertion during mating flights and threadfall. The ichor circulates within a network of flexible tubes known as ichor vessels, of which there are three types. Arteries are strong, muscular, elastic-walled vessels that carry ichor away from the hearts and towards the tissues. Veins are thin-walled and carry ichor back to the heart. Ichor is squeezed through the veins by the action of the surrounding muscle and is kept flowing towards the hearts by one-way valves. Capillaries are the smallest ichor vessels and bridge the gap from arteries to veins. The force, with which the hearts pumps the ichor through these vessels, and around the body, is known as the 'ichor pressure'.

Cardiovascular problems sometimes occur in older dragons, or in those dragons who's hearts are under terrific strain from other injuries or circumstances. As a dragon ages, the hearts often weaken and may develop problems, such as an erratic beat, or incorrect ichor pressure which may cause loss of feeling, or a tingling sensation, in extremities. Exertion, such as in a mating flight, may also cause a sudden onset of cardiovascular problems, such as a heart attack. This can result in a dragon going *between*.

Assess the situation: Reassure the dragon, get a gold to calm the dragon down if necessary, and ask questions of the rider about other signs.

Determination: Is there severe pain or weakness? Does this extend down one wing/forelimb or the other? Is there general lethargy? Are the hearts beating regularly?

Treatment:

Dragon should be pulled from a fighting wing, and allowed only light exercise, but daily. They should be closely monitored, and kept in low stress situations where possible.

Recovery: A dragon will never fully recover from any cardiovascular problem of this nature. Symptoms may be managed, but exertion should be avoided at all cost.

Dehydration

The lack of adequate body fluids for the body to carry out its normal functions and operate at an optimal level (by loss, inadequate intake, or a combination of both) is a classic definition of dehydration. In dragons it can be caused by diarrhea, usually after a constipated dragon has been purged, from consistently flying at high altitude for long periods of time, desert climes, and also from loss of ichor.

It is imperative that dehydration is treated as soon as it is identified. Mild cases are often cured by oral rehydration, but for moderate to severe cases of dehydration, intravenous fluids will be required.

Assess the situation: If the dragon been treated for an illness or injury recently, then you may need to look for further complications resulting from this, and leading to dehydration. For example, veins that have not been sutured correctly, or that have not been identified as ichoring. Has the dragon been recently purged? Have they been doing sweeps in the desert? Flying high altitude sweeps?

Determination: Is there decreased urine output? Does the hide lack its normal elasticity? (You can test this by pinching the hide into a fold, and watching it return - does it sag? If yes, then they have poor hide turgor). Is their hide graying? Do their hearts seem to be beating faster? Do they have a dry mouth? Does their stomach hurt?

Treatment:

1. If dehydration is mild, then ensure that the dragon starts drinking a lot of water, and continues to do so until they are recovered. Water should always be provided for a dragon after any treatment by a dragonhealer as a mostly precautionary measure.
2. If the dehydration is moderate, try treating with water, and watch for 3-4 hours. If there is no sign of improvement, treat as severe dehydration.
3. For severe dehydration, you must try transfusing the dragon with ichor from another dragon. Following the steps for removing ichor, and then inject this into a vein. You must inject slowly, or you risk having the vein collapse. Needless to say this is very bad. If this does happen, you need to inject ichor at a lower point on the vein to where you were injecting, and hope that you have the same vein. This is a very delicate procedure, with a lot of inherent problems and should only be carried out by experienced dragonhealers.

Recovery: Depending on the severity, recovery may take a couple of days to upwards of a month.

Dislocations

The displacement of a bone at a joint can be caused by a strong force wrenching the bone into an abnormal position, or sometimes by violent muscle contractions. Additionally, there may also be tearing of the ligaments associated with this injury. The most often affected are the hip, shoulder, digits and the jaw bones.

Dislocations can usually be differentiated from fractures by severe, 'sickening' pain, when the injury site is touched as compared tenderness.

Assess the situation: If the dragon is in pain, then ask a Gold to 'dampen' the pain and still the movement. Involve the rider. Ask the rider for details of the injury, and keep them with you (don't get them too drunk, you need to ask them questions!). Take control of the situation, but never forget to ask a rider first for permission to approach their lifemate - big dragon, in pain, equals a dangerous combination.

Determination: Is the injury bent at an impossible, or distorted, angle? Is there any swelling? Is mobility restricted? Was a cracking noise heard? Is it tender over the area? Is that pain 'sickening'? Ask, as many questions as you can think of, as soon as possible, while both dragon and rider are still conscious because both are likely to be distressed. If the answers are: Yes, it's a 'sickening' pain, there was a popping noise heard when the injury occurred, there is difficulty moving the area affected, there is distortion and swelling; then you are dealing with a dislocation.

Treatment:

1. Immobilize immediately, get weight off area and support if possible, use tables, or other dragons.
2. Pull steadily in a line with the bone, keeping it as straight as possible. You will have to have assistance from a larger dragon. You will have to exert quite an immense amount of force to get the joint to re-align.
3. Splint with tree-trunks. There are always tree trunks available for this purpose in the dragon infirmary.

Recovery: Full recovery will take approximately two-four months. Soaking in the lake/ocean and doing gentle exercise in the water can reduce the swelling and help promote recovery. Dragons should be careful of repeat dislocations to the injury site, as this area will now become prone to this type of injuries. Please do note that dislocated joints are relatively uncommon among dragons, although they can and do happen.

Eye Problems

Unlike humans, dragons do not have eyelashes. Instead their eyes are protected both by prominent eyeridges that protrude out over the eyes, and by three sets of eyelids. The inner lid is transparent, with the middle lid thicker and more opaque, and the outer lid seemingly part of the actual hide of the dragon.

Dragon eyes protrude outwards from their eyesockets, and as such provide peripheral vision that extends to the airspace above them, an extremely useful tool in threadfall. Their eyes are multifaceted, and are said to be 'whirling' with expression of emotion. However, this is actually an optical illusion provided by the facets. The eyes change color with emotion. Hues of green and blue signify contentment; yellow indicates fear; red-orange signals anger; red expresses hunger, white denotes danger and purple suggests love and/or mating urges. Additionally, dragons, like their Watchwher cousins, can see in the dark. Watchwhers, though, while having excellent sight even in total darkness, are photophobic, and have poor focal length. Dragons on the other hand have good focal length, being able to see objects on the ground from at least several dragonlengths above ground, if not further.

Dragons can, if the pairing between the rider and dragon has been sufficiently developed, use their rider's eyes to see something if they are not present themselves. This bond, usually developed in weyrlinghood can be strengthened by forcing the rider to rely on dragonsight, and likewise with dragon to rider.

Whilst rare, eye loss can, and does, happen. It is always the result of a serious accident, often this being the consequence of a mating flight, either pre-flight blooding when talons are bared in an relatively small area (the feeding grounds), during the flight itself when jockeying for position becomes a problem. Occasionally, eye loss may happen as a result of threadfall. The loss of a single eye will not completely disable a dragon. Their balance may be affected, but they should be able to compensate for most of this once the loss becomes accepted. However, this injury will always retire them from the fighting wings, since they will be blind on one side. It is unknown how the loss of two eyes would affect a dragon, though it is postulated that they would go *between* at this stage, since it would essentially ground them, and make hunting/eating a near impossibility.

Assess the situation: If the dragon is in pain, then ask a Gold to 'dampen' the pain and still the movement. Involve the rider. Ask the rider for details of the injury. If this is the result of a mating flight, make sure you start handing the rider skins of wine. Take control of the situation, but never forget to ask a rider first for permission to approach their lifemate - big dragon, in pain, equals a dangerous combination.

Determination: Is the eye absent? Is it ichoring? Is it damaged? Is it just the socket, or is it the eye as well?

Treatment:

1. First, slather the injury with numbweed, and let it soak in to take effect.
2. Clean ichor away, and check that it's not damage to an eyelid, or to the eyeridges blinding their vision.
3. Clean injury with redwort as there is a high chance of infection from this injury.
4. If the eye is damaged, but not severely so, then suture eyelids shut, coat with numbweed. It may be that the tissue will regenerate.
5. If the eye is damaged beyond what is treatable, then remove the damaged tissue with a sharp, sterile knife, and coat with numbweed. If other structures look damaged you may have to suture the eyelids closed.

Recovery: Obviously some of this injury may or may not heal. Use judgement to determine whether or not to remove the stitches in the eyelid for the complete eye loss, this will take around six to seven sevendays to heal. For the eye damage you should remove the stitches after about a sevenday. The dragon may have some loss of sight, or may not. Make a determination on their fighting capacity based upon their sight loss.

Talon Loss

Dragon talons are similar in nature to canine claws, and even our own fingernails. They are made of keratin, and grow out from a talon bed, which is situated in the foot pad. Thus, the talon itself has no nerves associated with it, and therefore no feeling, until it reaches the point where it grows from the talon bed. There it is nourished with ichor and nerves. However, that's not to say they cannot feel by association through their talons, though it is more correct to say that they feel the connection through the talon to the talon bed.

Talon loss becomes quite common when young dragons are learning to fly. However, it remains a risk throughout life, especially in those dragons that are injured or sick, or otherwise impaired. It is then that take off and landings can cause a talon to break off, either fully or partially, particularly on hard surfaces, such as rock and compacted dirt.

Though much rarer, talon loss can also occur in mating flights, whereby talons are lost by fighting males. Hunting may also result in the loss of a talon, particularly when the captured beast is of a sufficient weight that a wrong move will wretch the talon from the bed of the foot.

Assess the situation: If the dragon is in pain, then ask a Gold dragon to 'dampen' the pain. It's likely that the pain will be fleeting, with the wrenching occasionally accompanied by nausea, which will then lessen to a throb. Ask the rider for details of the injury. If it's a flight injury, give the rider a skin of wine unless you want their affections coming your way (not advised until *after* you've dealt with the dragon), otherwise the rider should only be affected a little, with an uncomfortable feeling predominating.

Determination: Is there any talon left? Is the talon hanging at an awkward angle? Is there dirt associated with the remaining/lost talon? Is there ichor pooling around the talon bed?

Treatment:

1. Clean the area around the talon bed with redwort if infection seems likely. If there's some ichoring, then use apply numbweed immediately.
2. If the talon is torn, determine whether it would be more fortuitous to remove the complete talon, or remove the damaged portion. If you decide to remove the talon, make sure that the talon bed is fully numbed. The talon is mostly dead, you do not need to numb this, only the bit near the bed is bed is living tissue.
3. The assistance of another dragon may be required to remove the talon, depending on how severe the injury. If it is hanging from the talon bed at an angle use a sharp, sterile knife to remove it, severing through as little tissue as possible so as not to damage the talon bed.
4. If the talon can be saved, remove the part that is damaged with a sharp knife. You will need to numb the talon bed with numbweed, otherwise the dragon will feel uncomfortable pressure in this area during the procedure.

Recovery: The talon should eventually grow back, taking between four and eight sevendays to do so. However, any injury site will close within a day or two. Occasionally a talon may not grow back if the talon bed is sufficiently damaged. However, this will not impair the dragon in any way, as they will quickly learn to compensate for the missing talon.

Drawing of Ichor

Ichor is to dragons what blood is to mammals. Copper-based as opposed to iron, it is a dark green in color. In some cases it may be necessary to withdraw blood from a healthy dragon for transfusion into an injured one. A syringe is necessary for this operation. The essential components for a syringe are the glass body of the syringe itself, needlethorn, and wax. Needlethorns need to be long enough to get through hide, muscle, and tissues to the veins—3 inches or longer. They're strong enough to use for injections, so bending or breaking should not be a problem. The larger the aperture of the needle, the more ichor can be drawn, and the maximum aperture should be used wherever possible. The wax is obtained from a tree and is used to attach the needlethorn to the body of the syringe. When kneaded, the wax becomes a soft gel, which enables it to seal the syringe as it hardens.

Everything (and we do mean everything) needs to be sterilized for this process. To sterilize, boil the syringe in water for approximately an hour, wash it in redwort, then rinse in boiling water. Needlethorns must not be boiledit makes them soggyinstead wash them in redwort and rinse them in water. Mold the wax around the entrance of the syringe, then secure the needlethorn in place before allowing the wax to seal off the juncture between thorn and syringe. Needlethorn should never be re-used, as it increases the chances for infection, but syringes should be re-sterilized (they are expensive, so care must be taken when using them with oily hands).

Symptoms of a dragon needing a transfusion of fresh ichor are complaints of unslakable thirst on the part of both dragon and rider. Dragon hide will be grey in tone, and the dragon will be lethargic. In the case of dried-out cartilage following a wing injury, the dragon will likely be distressed, dehydrated, and parched.

Assess the situation: If the dragon is delirious, enlist the assistance of a gold dragon to dampen the pain and keep the dragon still enough to administer the cure. Get assistance, a healthy dragon to withdraw ichor from and the necessary equipment as soon as possible.

Determination: How long has the injured area been without steady ichor flow? Are the cartilages only slightly drier than they should be, or completely dried out? Is the dragon ichoring from a body wound that was improperly sutured, or not sutured at all? Make a thorough examination of the dragon in question. You will most likely not be able to ask the dragon's rider, because wounds like this are generally accompanied with a serious amount of delirium.

Treatment:

1. Check for, and treat, any complications from wounds.
2. Remove ichor from a healthy dragon, and use it to treat the sick dragon. Clean the hide of a healthy dragon with redwort, usually over a bone (wing bones are good for this), and then palpate the hide for a vein. Then, using a syringe, puncture that vein, and remove ichor from the dragon. Once the syringe is filled, carefully remove the needle from the vein, and hold a redwort-soaked pad over the needle entrance point for a few moments.
3. Infuse into the area that is being drained of ichor. Even dropping the ichor on externally can aid greatly. If the area is cartilage, use the following directions:

a. Suture the vessels that are ichoring.
b. Remove ichor from a healthy dragon (see above instructions).
c. Apply ichor directly to the dried-out cartilages and joints as necessary.

Recovery: Anywhere from one month to one Turn, depending on the severity of the injury and any complications. With dried-out cartilages, recovery time depends on the severity of the wing injury, but will generally be at least a few months. Dehydration should be treated as quickly as possible.

Severe Threadscore

This encompasses all serious injuries that are to the body of the dragon as opposed to the wings. Wing injuries require a highly specialized technique, and are covered in the Wing Damage target. The symptoms are again clean lacerations of a burned nature with blackened edges, though much deeper and more widespread than those covered in the Basic Threadscore target. Ichor may be pooling from severed vessels (generally veins, as arteries are too deep to be affected by most Threadscorings). Rider and dragon will both be distressed to varying degrees. The assistance of a queen dragon may be required to restrain the injured dragon if the Threadscoring is severe enough in nature.

Assess the situation: The rider should still be conscious, though more than slightly distressed at the condition of his lifemate. For severe bodily scorings, the assistance of a gold dragon will be required to dampen the pain and keep the dragon still enough for you to do your job. Take control of the situation, but make sure you ask the rider before approaching the dragon. A large animal in pain could equal Shredded Dragonhealer if you're not careful. Get the details of the injury from the rider, inasmuch as you can.

Determination: Where is the injury? How widespread are the lacerations? How was it obtained? How exactly did the clump of Thread strike the dragon? Keep talking to the rider if at all possible, to keep him lucid and in the here-and-now. It is also useful to keep the rider from panicking at his lifemate's injury. Do your best to assess exactly how the clump of Thread hit the dragon as this can help determine the best way to treat the wounds.

Treatment:

1. If wound has become dirty, clean quickly and thoroughly with redwort solution.
2. Coat wound thoroughly with numbweed.
3. Use surgical clamps on either side of any severed vessels to restrict the flow/loss of ichor and to make your job easier.
4. Suture any severed vessels as quickly as possible without rushing. The longer tissue is left without a steady ichor flow the less healthy it becomes. However, this is no excuse for rushing and making avoidable mistakes.
5. Remove clamps.
6. Clean out the wound with redwort. Check for formation if ichor around the vessels. It may be necessary to clean away some of the numbweed with oil-soakedcloth pads. This is important, so check carefully. You may need to reapply the numbweed after this step.
7. Stitch together muscle, then hide.
8. Apply numbweed to the entire stitched area.

Recovery: Severe scorings are likely to keep the dragon out of the air for at least a sevenday, if not more. It is vital during recovery time that the dragon replace lost fluid. A tub of water should be kept near the dragon at all times.

Advanced Bonesetting

There are three main types of fracture, and two states of fracture. These are Simple, Comminuted and Greenstick types of fractures, and then open and closed states of fracture. This section will concentrate on more complicated fractures, which are consequently harder to deal with.

Fractures may be associated with an open wound, and complicated by damage to other structures. An open wound fracture, or a compound fracture, means that immediately you have a greater risk of infection, both in treating the injury, and subsequently. When the hide remains closed over a break, there is often substantial swelling and bruising.

Often a broken bone is obvious, but occasionally they occur distal to the point of impact. Not only this, but they can be further complicated by being a fracture with multiple bone fragments (comminuted), or a greenstick, in which the bone in a young dragon splits. In the former case it may be necessary to remove some of the bone fragments. However, if this is not possible, there appears to be an internal mechanism that accomplishes this, though recovery is substantially longer. The dragon may also complain of 'grinding' at the point of injury, and this may never be corrected. Rest therefore, particularly immediately after injury is fundamental to healing this type of injury. Greenstick fractures, whilst traumatic for the weyr as the young dragon is likely to broadcast loud and clear what pain it is in, aren't problematical from a healer standpoint. They heal quicker than most fractures, and have few, if any, complications.

Once you have correctly diagnosed the injury, the fractured bone should be straightened and returned to its normal configuration. You may have to request the aid of other dragons in order to accomplish this. The injury should then be stitched if applicable, splinted securely, elevated if possible, and an attempt made to prevent motion of the bone wherever possible.

Assess the situation: If the dragon is in pain, then ask a Gold to 'dampen' the pain and still the movement. Involve the rider. Ask the rider for details of the injury, and keep them with you (don't get them too drunk, you need to ask them questions!). Take control of the situation, but never forget to ask a rider first for permission to approach their lifemate - big dragon, in pain, equals a dangerous combination.

Determination: Is the injury bent at an impossible, or distorted, angle? Is there any swelling? Is mobility restricted? Was a cracking noise heard? Is it tender over the area? Is that pain 'sickening'? Ask as many questions as you can think of as soon as possible, while both dragon and rider are still conscious because both are likely to be distressed. If the answers are: Yes, it's bent at an impossible, or distorted, angle; mobility is restricted; there was a cracking noise; the area is tender; and there is swelling; then you are dealing with a fracture and not a sprain nor a dislocation. Next determine whether the injury is open or closed, if it is a comminuted, or greenstick fracture. If comminuted and open, multiple fragments will be seen, if comminuted and closed, you should be able to feel them under gently probing fingers. Additionally a comminuted fracture isn't usually bent at such a severe angle as a simple bone fracture, although there is a higher possibility of it breaking through the hide. A greenstick will almost always occur in any dragon under 18 months of age, and will appear as more of a bend in the limb, rather than an awkward angle. If uncertain, treat as a simple fracture.

Treatment:

1. Immobilize immediately. Support if possible, but get weight off area. Remember, dragons are huge! You may need to enlist the help of other dragons, and or use a ladder/table to properly treat this injury.
2. Wash your hands in redwort, water, and then coat then in oil. These will help prevent infections, and protect them from the numbing effects of
numbweed. If instruments are needed, presoak these in redwort.
3. Numb the wound and then make thorough assessments. It is likely that for most broken bones (wings and toes) numbweed will be enough to deaden the pain, but for larger bones (leg bones, etc), the numbweed will not penetrate the hide deep enough to work. However, if you are dealing with an open wound, cleanse first with redwort to disinfect the area, and then apply a liberal coat of numbweed.
4. Pull steadily in a line with the bone, keeping it as straight as possible. You will have to have assistance from a larger dragon.
5. If the hide is open, stitch the wound closed. Stitches for injuries are unlike stitching clothes. Each stitch is separate from the next, each one basically a separate knot from the other. Stitches are made by pushing a needle through one edge of the hide, then through the other. A loop is then made with the thread of the second entry, and the first part of the thread pulled through this, pulling it closed, and closing the wound. A dragon will need a lot of stitches. This can take a long time. Remember to recoat your hands with oil so that they do not become numb. Stitching should be performed so as not to pucker the hide but still provides a barrier to infection (ie. not too tight and not too loose).
6. Splint with tree trunks, branches or other materials that have been prepared before hand. Supplies of these are kept in every dragon infirmary.
7. Move the dragon to the infirmary or a ground weyr. Other dragons can be used to help with supporting the injured one. Make sure that they have plenty of water to prevent dehydration.
8. Soaking in the lake/ocean will help further with swelling reduction, but support will be needed to and from the lake/ocean. The wound will need to heal somewhat before this is done if the fracture was an open one. Once the bone has begun to knit (approximately half the recovery time), then gentle exercise may begin to bring muscle strength back. It is recommended that these start in the water.

Recovery: This will vary, depending on the age of the dragon and the severity of the break. Figure on two months for a minor break (wingbone) and six months for a major break (leg bone). Some dragons will be permanently disabled after fractures, and might not be able to launch from the ground, fly in a straight line or fly an entire Threadfall.

Advanced Pharmacology

Aloe

Characteristics: Aloe can be characterized by its rosette of long, tapering, fleshy leaves that exude a thick sap when broken, aloe rarely grows more than 60 cm tall. There is no true stem or branches; the main body of the plant is merely the place from which all the leaves grow. Although it only grows in warm, dry regions, it also exists in pots throughout Pern. On the rare occasions that if flowers, it will grow a long flower stalk anywhere from one to six meters long, with yellow to red flowers that are quite pretty.

Uses: Burns and rashes. Can help to reduce scarring, and soothe itching.

Preparation: Unfortunately, aloe gel does not keep, extract, or dry very well, and is best used fresh. Any place that can grow it is strongly recommended to do so. To use, remove a leaf from the base of the plant with a sharp knife, and squeeze the fleshy part.

Fellis

Characteristics: Fellis grows as a small, branchy tree easily recognized by its star-shaped yellow blossoms. The juice made from the leaves and stems is a powerful narcotic painkiller, with addictive tendencies. It is widely used in the Healing profession, but is always used with caution, and never where a lesser remedy will suffice.

Uses: Fellis juice is extremely bitter, is rarely given undiluted, being generally diluted in wine. It is extremely toxic to dragons, and even the smallest draft will cause a fatal reaction. Dragonhealers therefore only need to know how to recognize and know not to use this herb in any form

Needlethorn

Characteristics: Needlethorns are the spines of a succulent bush, which grows in the tropical regions of Pern. During the growing season, the plant will shoot the toxic spines at anything that disturbs it, but when the flowers of the Ging trees which grow nearby open in the autumn, the plant is dormant and the spines can be safely gathered.

Uses: The hollow needles are strong enough to be used for drawing ichor.

Preparation: When the Ging trees are flowering, Needlethorns should be gathered from the bushes and either placed in a basket or wrapped in the leaves of the Ging tree. Before use Needlethorns should always be carefully sterilized with redwort and rinsed with boiling water. They can be stored for long periods of time wrapped in thick, sterile cloth, or kept in a sterile box. They should never be re-used; to do so introduces an unacceptable risk of infection.

Numbweed

Characteristics: Numbweed is a succulent plant, which grows in greatest profusion in the semi-tropical and tropical regions of Pern, although it can be found in all areas.

Uses: Numbweed sap deadens all feeling on contact, but in its raw form it can blister the skin, and so is always used as a salve. It takes approximately 3 secs for Numbweed to penetrate the outer layer of dragon hide and slightly longer to go through to the germative layer. Numbweed is always used in its salve form by Dragonhealers. It is non-addictive, and in its salve form presents no danger of overdosing. Oil should be used to protect the hands when working with Numbweed for a long time. Redwort can be used when the contact will be for a short period of time

Preparation: Numbweed leaves are gathered, crushed and placed into a huge vat. They are then boiled until the Numbweed turns a pale yellow color. The leaves are strained and the resulting liquid decanted. This is an extremely malodorous process, and a face scarf is highly recommended.

Redwort

Characteristics: Redwort is a small, shrublike plant which may be recognized by the reddish veins in its stem and its flat-topped reddish-purple flowers.

Uses: Redwort has two main uses: an antiseptic wash to prevent infection, and as a defense against the effects of Numbweed. All tools should be washed after use in very hot water with plenty of Sweetsand, and then rinsed in Redwort before storage in a sealed container. A tool whose sterility one is not certain of should be rinsed in Redwort before use. A healer should wash his or her hands well and then apply Redwort before touching a wound. Open wounds should be rinsed well with water, bathed with Redwort, and rinsed again to remove the Redwort before Numbweed is applied, as its protective effects are undesirable in that case. Healers should take care to apply Redwort and a light coat of oil to their hands before performing arduous work, such as stitches, on a wound coated with Numbweed, and to re-apply frequently to avoid losing feeling in their hands. The use of Redwort leaves a red stain on the skin which resembles a very localized sunburn.

Preparation: Redwort leaves are gathered, and boiled until the tincture has been removed from the leaves, basically when the leaves turn colorless, or dull, from their normal reddish-purple color. Leaves are strained and the resultant Redwort stored. The Redwort, in this form, is extremely concentrated and will need to be diluted with pre-boiled water before use.

Riders and Dragonhealers

Occasionally there will be times when the Dragonhealer needs to see to the immediate care of a rider. If the rider can be of ANY assistance, ensure that they do not get drunk. Instead use them and talk through them to the dragon. Reassure the dragon and rider in one go! If they really can't be of any help, hand them the nearest wine skin, and let them drink themselves into oblivion. If the rider is injured, and all the healers are busy, you may have to treat both rider and dragon so that they both calm down. Immediate care is all that's necessary here. Ensure that no Thread spores have caught and survived *between*, say for example in a flight jacket. If they have, douse them thoroughly with water. If you have a Threadscore or burn, Numbweed is the answer. Don't do anymore than that, leave it up to the Healers. If the injury is serious enough to cause you concern, send a runner immediately for a Healer's assistance. It is doubtful that when treating a dragon, because of their sheer size, you would have time to care for a rider even if you did have the required skills.

Wing Damage

Threadscored Wings

A dragon's wings are the most important part of their anatomy from a practical point of view. After all, the dragons were bred specifically to be an effective aerial fighting force, and in order to fulfill this goal, usable wings are a requirement. Wing injuries are some of the most delicate and involved repairs any dragonhealer can ever do.

Light Scoring:
Generally, a light wingscoring is the result of poor judgement on the part of the rider. These injuries will consist of light tracks, the occasional hole, and maybe scores along the edges of the wing, and both dragon and rider will be uncomfortable.

Moderate Scoring:
This will most likely include damages to edges and sails, but not to cartilages. The rider will probably be uncomfortable, and the dragon will be in some pain.

Severe Scoring:
These are the injuries every dragonrider dreads. The sails, cartilages, wingbones, and veins are all likely to be affected by these injuries. These are the kind of wing reconstruction jobs that are described in-depth in Moreta: Dragonlady of Pern (© Anne McCaffrey). The injured dragon will have to be restrained by a queen or perhaps two, depending on the severity of the injury, and the rider will most likely need to be plied with a great deal of wine.

Assess the situation:. Wing damage is the most painful of all draconic injuries to treat. For any injury that is moderate or worse, you will need the assistance of at least one queen dragon to hold the injured beast still. If the injured dragon is a queen, it might take multiple dragons to hold her. The rider will most likely have to be plied with enough wine to make him unconscious. Make sure the rider is also cared for—oftentimes severe wing injuries to a dragon will be accompanied by injuries to the rider as well, something that can be overlooked in the general hubbub surrounding the dragon.

Determination: You will most likely not be able to talk to the rider about the injury, so don't worry about keeping him or her lucid. Instead, get them out of the way, try wine, works wonders! Try to determine exactly how the clump of Thread hit the wing—did it land on the leading edge or the trailing edge? Are there any body injuries that resulted from the same clump of Thread? Make sure you assess the extent of the injury carefully to avoid missing anything important.

Treatment:

1. Slather numbweed over everything. The more, the better.
2. Check to see if the ichor is beading properly on the cartilages of the wing. If it isn't, check first for any severed veins that will need suturing first. Clear away the numbweed with oil-soaked cloth pads before checking.
3. Splint bones if necessary. Major gouts of Thread are liable to sever the thinner bones in the wing. Stiff reeds will serve admirably as splints for these bones.
4. Cut lengths of the finest cloth available to the measure of the length of the leading or trailing edge of the wing. Avoid using things like brocades or slippery fabrics, as the wing tatters will slide around on them.
5. (This step will take at least two people.) Stitch the cloth to the wingbone, thereby providing a support mechanism for underneath the wing. The cloth will need to be alternately stretched and relaxed during the stitching process to provide a firm surface underneath the wing.
6. Fasten the cloth to the underside of the wing with small stitches. Be careful not to place them too near a torn area.
7. Brace the trailing edges of the wing if necessary, securing them to the cloth. Lay the wing fragments carefully on the fabric as close to their original positions as you can ascertain.
8. Apply thin numbweed liquid in quantity to the fabric.
9. Float the wing fragments on the numbweed liquid in some order, and stitch wherever possible.
10. If any tendons are damaged due to stretching or tearing, they will need to be supported by thin basket reeds stitched to the tendons in question.
11. Cover with more numbweed!

Recovery: Recovery time can be anywhere from a few months to a full Turn, depending on the severity of the injury. The use of the cloth and the reeds provides a framework for the new wing growth. The wing cartilages must be monitored to avoid their drying out. If they do begin to dry, then ichor drawn from a healthy dragon must be applied (see Drawing Ichor). As the wing heals, scar tissue will form spots of unsightly thickness. At first this will imbalance the dragon, but after time the dragon will learn to compensate, and wind-sand abrasion will thin the scar tissues down to normal thickness. Injuries on the inner wing are more serious, as Thread can, depending on the angle, sear through the wing down to the body.

Wrenched and Dislocated Wings

This problem is not nearly as prevalent with proper care than Threadscore injuries. In fact, it is almost more likely to see it on firelizards than on dragons. Nevertheless, how to replace a dislocated joint is something that should be known should the situation arise.

The dragon in question will most likely have to be restrained by a queen for this process, as it's bound to be painful as all get out. Symptoms include a severe, 'sickening' pain in the affected area, distortion of the joint, and swelling.

Assess the situation: Wing damage is the most painful of all draconic injuries to treat. For any injury that is moderate or worse, you will need the assistance of at least one queen dragon to hold the injured beast still. If the injured dragon is a queen, it might take multiple dragons to hold her. The rider will most likely have to be plied with enough wine to make him unconscious.

Determination: You will most likely not be able to talk to the rider about the injury, so don't worry about keeping him or her lucid. Instead, give them wine and get them out of the way. Make sure you assess the extent of the injury carefully to avoid missing anything important. Was the pain 'sickening'?

Treatment:

1. Immobilize the area and get as much weight off it as possible. Another dragon supporting the damaged wing helps.
2. With the assistance of a larger dragon, pull steadily in line with the bone, keeping it as straight as possible.
3. Splint with tree-trunks, and treat as a bad sprain.

Recovery: Approximately two-four months. A soak in the lake can reduce the swelling. Dragons should be careful of repeat dislocations to the injury site and recovery time should allow for gentle exercise before he/she is ready for duty. Dislocated joints are relatively uncommon among dragonkind, although they do happen.