Our Bodies, Our Brains - The Most Valueable Tools In Play/BDSM

[catalina_francisco]

While not wanting to make judgements, nor promoting a one way only policy, I have become concerned with the influx of recent postings here and elsewhere promoting violence to the extreme and unsafe as wonderful edgy ways to play. Some of us play harder than others, some enjoy ways others deem as too risky or distasteful (we have often defended our right to be one of these), but I am more concerned with the posters who either choose to disregard the real permanent dangers to health, or from their words show they are not even aware what risks they are taking or allowing to be taken with their bodies. To me, you need both a brain and a body to enjoy your play, so why not educate and protect yourself and others before, rather than later?

It is also true we have a lot of valueable posters on the board whose profession it is to know this information and see the results of injury, temporary and permanent, everyday in their work. I did a search, and while I found many threads on SSC, consent, bondage safety, I could not find any on the risks we take in play and how to guard against them as best we can without losing our play. I thought it might be good to utilise the resources we have from both health professional and regular posters in providing a thread that can highlight the safety issues which not heeded can mean the difference between leading a full life and death or permanent, disabling injury. I am not looking to just voice what is dangerous, or personal choices, but more a sharing of knowledge such as what areas of the body to avoid when whipping, and why. I find things easier to remember if I understand why it is not safe to do whatever etc., and suspect it is the same for many others.

For me, the brain is one of the most delicate and important body parts we have. It is what has been named by more than Master as one of my best assets, so it is important for me to protect that for my Dominant's further enjoyment and use....so that is where I have started this thread, but hope we will collectively move through the body, spine, bones, tissues etc., to provde a valueable resource for all, new and experienced. I think knowledge from posters is best, but as I am not medically trained or have direct experience with some who have experienced or seen injuries in others, I have begun with a couple of sites and statements/information I have found with the dreaded google monster. I hope others will share their knowledge here.


"A direct blow to the head can be great enough to injure the brain inside the skull. A direct force to the head can also break the skull and directly hurt the brain. This type of injury can occur from motor vehicle crashes, firearms, falls, sports, and physical violence, such as hitting or striking with an object. "


"A knock or blow to the head, such as in a road traffic accident, can cause brain damage at the time of injury. This occurs as a result of damage to soft brain tissue when the brain rattles against the skull. There does not need to be a visible injury, such as a fracture to the skull, for brain damage to occur."

"The effects of a blow to the head on brain function arise from the structural characteristics of the skull and the brain and the direction and size of the forces acting on the head. The brain, a rather soft tissue with the consistency somewhere between egg white and jello, is covered by three membrane layers. The outer-most layer, called the dura mater, is connected to the inside of the skull at various suture points which serve to suspend the brain within the skull. The brain sits atop the brain stem, an extension of the spinal cord which passes out the base of the skull through a hole called the foramen magnum. Brain injuries arise from three characteristics of this brain-skull anatomy: the rigidity and internal contours of the skull, the incompressibility of brain tissue and the susceptibility of the brain to shearing forces.

The first two characteristics give rise to contusions or hematomas (i.e., bleeding) on the surface of the brain, one of the most common injuries. There are usually two contusion sites in a brain injury. One occurs at the site of the blow to the brain and is called the coup injury. The other arises where the brain bounces off the skull when it has been moved away from the site of the original blow. The contusion here is termed the contre coup injury. Some bleeding may also arise at the suture points when the dura mater is torn away from the inside of the skull.

The third characteristic, susceptibility to shearing forces, plays a role primarily in injuries which involve rapid and forceful movements of the head, such as in motor vehicle accidents. In these situations rotational forces such as might occur in whiplash-type injuries are particularly important. These forces, associated with the rapid acceleration and deceleration of the head, are smallest at the point of rotation of the brain near the lower end of the brain stem and successively increase at increasing distances from this point. The resulting shearing forces cause different levels in the brain to move relative to one another. This movement produces stretching and tearing of axons (diffuse axonal injury) and the insulating myelin sheath, injuries which are the major cause of loss of consciousness in a head trauma. Small blood vessels are also damaged causing bleeding (petechial hemorrhages) deep within the brain.

Collectively these injuries can result in swelling of the brain. If the pressure within the skull is not relieved through surgery, cooling or medication, the brain will gradually be pushed down through the opening at the base of the skull, the foramen magnum. Nuclei in the brain stem controlling breathing and cardiac function will eventually be compressed resulting in death. "

http://www.biausa.org/Pages/causes_of_brain_injury.html

(http://www.ahs.uwaterloo.ca/~cahr/headfall.html)

http://www.headinjury.com/tbitypes.htm

Catalina

 

[ownedsubgal]

i think this could be a wonderfully helpful and informative thread, as long as it doesn't come to that dreaded point of "should" and "should not"s...(i.e. "you should not hit someone here")

speaking of the head, my Master chooses not to give me any hard blows on or directly around my ears, because of an experience he had himself in adolescence where such a blow from a classmate caused him to be deaf for an hour or so.

 

[catalina_francisco]

i think this could be a wonderfully helpful and informative thread, as long as it doesn't come to that dreaded point of "should" and "should not"s...(i.e. "you should not hit someone here")

speaking of the head, my Master chooses not to give me any hard blows on or directly around my ears, because of an experience he had himself in adolescence where such a blow from a classmate caused him to be deaf for an hour or so.

I agree osg. I think it is probably inevitable at some point someone is going to want to debate an issue or pronounce some form of play as not OK etc., but I am hoping for the most part to provide a wealth of factual based information as a resource, all in one place reference, for those who want to know the legitimate risks and how best to avoid them. Thanks for your input, it is appreciated.

Catalina

 

[catalina_francisco]

i think this could be a wonderfully helpful and informative thread, as long as it doesn't come to that dreaded point of "should" and "should not"s...(i.e. "you should not hit someone here")

speaking of the head, my Master chooses not to give me any hard blows on or directly around my ears, because of an experience he had himself in adolescence where such a blow from a classmate caused him to be deaf for an hour or so.

This is an interesting point actually as I have counselled several women who are permanently deaf from blows to the head, and particularly ears, some who have lost sight from head trauma, a few with faces reconstructed with metal plates to hold them together, and a few who had lost the function of facial nerves on one side of the face leaving them permanently disfigured and unable to smile or move the face in any way. One of the saddest was a lady who had lost partial hearing, sight in one eye, and after unsuccessful reconstructive surgery, her nose....all from 2 misplaced blows from her spouse which she herself felt were not that hard.

Catalina

 

[Quint]

This is an excellent idea. Thank you.

I personally am interested in the effects of slapping. As of now, we have been sticking to open-handed blows high on the cheek. I think I will look into the potential damage to the cheekbone from hard blows, as well as if there is any threat to the jaw or ears. Any information already gathered would be appreciated.

Oh, and this may seem perfectly obvious, but.....don't let your dominant take a frypan to your spine. Even in play.

 

[catalina_francisco]

This is an excellent idea. Thank you.

I personally am interested in the effects of slapping. As of now, we have been sticking to open-handed blows high on the cheek. I think I will look into the potential damage to the cheekbone from hard blows, as well as if there is any threat to the jaw or ears. Any information already gathered would be appreciated.

Oh, and this may seem perfectly obvious, but.....don't let your dominant take a frypan to your spine. Even in play.

LOL, speaking from personal experience with the frypan? If you find anything with the slapping please share as it would be worth knowing. Certainly can be jarring. I have known someone who had a broken cheek and jaw bone from a closed fist blow, but I daresay density and brittleness of an individual's bones will have influence too. There are so many factors to consider, and as much as I love my extreme rough play and cuttings, I only want permanent marks which have been predetermined, so the more info the better as we have no intention of limiting our experiences out of unnecessary ignorance.

Catalina

 

[Netzach]

There's a fairly good article on faceslapping safely on FrugalDomme.com

This is how I personally choose to faceslap, but it's not going to be edgy enough for some bottoms. I play with people physically stronger than I am, and the slap is usually preceded by grasping the head, staring the other down like a dog and delivering a light slap to the cheek with open fingertips only.... accompanied by a verbal expression.

Remarkably effective on those for whom it's remarkably effective.

 

[catalina_francisco]

There's a fairly good article on faceslapping safely on FrugalDomme.com

This is how I personally choose to faceslap, but it's not going to be edgy enough for some bottoms. I play with people physically stronger than I am, and the slap is usually preceded by grasping the head, staring the other down like a dog and delivering a light slap to the cheek with open fingertips only.... accompanied by a verbal expression.

Remarkably effective on those for whom it's remarkably effective.

Thanks Netzach. I think there is always room for a variety of styles in anything, and this one sounds designed to fit without having to be over the top physically. IMHO subtle moves are to be appreciated as much as the traditional brute strength of others.

Catalina

 

[rosco rathbone]

Be careful with backhanding--it is a lot harder to control the angle of attack. I had a bit of a dicey moment with someone's nose. If you must do the alternating forehand- backhand---and 4 out of 5 leading pimps are with me on this---then lead with the pimpslap and grasp the hair firmly in order to immobilise and control the head; turning it away in the same direction that the blow is travelling in order to avoid putting most of the force of the blow on the nose bones.

 

[catalina_francisco]

Thought I would resurrect this thread before starting another over a health issue I have been thinking on for some time in relation to safety and limitations on play. I was wondering if anyone has had experience with physically dominating a submissive who may have severe blood pressure issues and/or heart conditions or chest pain.

My interest lies in how play can be continued safely....is it a matter of timing, adjusting play to milder forms during periods of concern? Are some activities more risky? For instance, I imagine flogging could be more risky than something less severe......my thinking is though the sub may enjoy it, the body may have a new limit or react badly to the force or shock factor. Hopefully there would be a way to safely continue loved activities in preference to removing them altogether.

Catalina

 

[catalina_francisco]

Though not typically the theme of this thread in it's original form, I thought this page still dealt with safety and might be of use to some. http://www.bdsm-peergroup.com/resources_safer_sm.htm

Catalina

 

[Gentle Baron]

Thought I would resurrect this thread before starting another over a health issue I have been thinking on for some time in relation to safety and limitations on play. I was wondering if anyone has had experience with physically dominating a submissive who may have severe blood pressure issues and/or heart conditions or chest pain.........
Catalina

I think I got your views on the original post........How the brain is O/our most powerful tool........I like to take that one pet and mentally attack her with words , phrases........Get the visualisations going.......Sigh how I miss these sessions......

 

[catalina_francisco]

Came across an interesting site S & M Dangers and Precautions which has tons of information on safety and medical issues to consider when playing. One piece of information Commotio Cordis and SM Play - Jay Wiseman I came across was in relation to blows to the chest bringing on fatal heart attacks, which I knew of some of the risks, but was unaware of the increased risk to younger players with more flexible ribs. Though it is not going to happen to masses of players, it is still good to be aware.

Catalina

 

[Netzach]

Came across an interesting site S & M Dangers and Precautions which has tons of information on safety and medical issues to consider when playing. One piece of information Commotio Cordis and SM Play - Jay Wiseman I came across was in relation to blows to the chest bringing on fatal heart attacks, which I knew of some of the risks, but was unaware of the increased risk to younger players with more flexible ribs. Though it is not going to happen to masses of players, it is still good to be aware.

Catalina

Re: Wiseman

but there is a way to determine high risk vs low risk, isn't there?

DONT PUNCH IN THE MIDDLE OF THE CHEST, ONLY HIT PECS/BREASTS. (and why are the female breasts ok for a glancing blow, but the male breast, which presumably also protects the vitals, not according to this? IMX, we're not structurally that damn different.)

 

[catalina_francisco]

Re: Wiseman

but there is a way to determine high risk vs low risk, isn't there?

DONT PUNCH IN THE MIDDLE OF THE CHEST, ONLY HIT PECS/BREASTS. (and why are the female breasts ok for a glancing blow, but the male breast, which presumably also protects the vitals, not according to this? IMX, we're not structurally that damn different.)

One would not think so considering how many women's drugs have been tested only on males to see if they are safe. Maybe it is the expectation of more padding on the female breast to add more protection though I for one know if things are not right with my body, this does not keep me from having some added stress to the system which can result in chest pain that is not related to bruising.

Catalina

 

[ownedsubgal]

my Master punches me in the chest quite often....but in the middle bony part, never my breasts. He says hard blows to a woman's breasts are incredibly dangerous, tho i'v never asked him why.?

 

[Netzach]

I was taught to do my punching in the pecs/upper breasts by someone who mainly plays with punching kicking and slapping and it made sense to me that sensitive fatty/muscly tissue was safer yet plenty painful to hit. I have seen some mostly anecdotal data that suggests repeated trauma via breast bondage to the breasts might increase the chances of tumors, but not a lot about punching/slapping/beating. I beat breasts a lot, some of my friends are complete tit torture fanatics and get whipped caned and slapped on the breasts a lot, some like punching there as well. I tend to aim for the pectoral. Even a woman of my stature who's not seen the inside of a gym much can still make a grown man squeak this way, so it's quite effective.

 

[Etoile]

sensitive fatty/muscly tissue was safer yet plenty painful to hit

Oh god yes. I've been hit in the breasts accidentally (in a non-BDSM situation) and it was quite painful. My preferred tit play is mostly nipple play - very harsh, please! - but I have been whipped on the tits a bit. The emotions from having it done by one's partner, though, are soothing compared to a completely accidental blow by a stranger.

 

[Etoile]

I have counselled several women who are permanently deaf from blows to the head, and particularly ears

Hey Catalina, I'm not sure why I didn't provide this link a long time ago when this thread originally opened, but here it is now.

The Deaf Abused Women's Network is in the United States and primarily serves women who started out Deaf but are also victims of domestic violence, but if you ever again come across women who have lost their hearing as a result of the trauma, the DAWN group might be useful. It would be a different cultural perspective - the women you work with started out hearing - but there could be useful elements like how a deaf victim can best work with a counselor or therapist, etc.

 

[catalina_francisco]

Hey Catalina, I'm not sure why I didn't provide this link a long time ago when this thread originally opened, but here it is now.

The Deaf Abused Women's Network is in the United States and primarily serves women who started out Deaf but are also victims of domestic violence, but if you ever again come across women who have lost their hearing as a result of the trauma, the DAWN group might be useful. It would be a different cultural perspective - the women you work with started out hearing - but there could be useful elements like how a deaf victim can best work with a counselor or therapist, etc.

Thanks Etoile....these links are great to have available for those who might need them as it is not always easy to find on the www when you are in the moment.

Catalina

 

[catalina_francisco]

Thought I would bump this with some more info in terms of safe, healthy play. Due to the occurrance of online links changing or disappearing, I will post the articles, plus their links to ensure the info is still there if anything shifts.

Breast Bondage and Safety

Healthy Breast Bondage
by Susan Wright (6/98)

( http://www.ds-arts.com/RopeArt/BreastSW.html )

_____________________________________________________________
This document brings together information available on breast trauma
and hypoxemia, usually quoting verbatim from the sources. Most of the
information in Healthy Breast Bondage was found on the internet and is
accessible by everyone (check the footnotes for the URL of the original
source). Sources include: medical doctors who perform breast reductions,
breast implants and plastic surgery; FAQs from the National Cancer
Institute and Long Island Breast Surgery; and study notes from Cornell
University and Emory University.

As a disclaimer, I don’t have a medical degree. I am a researcher and
I write nonfiction books on science and culture. I am grateful to several
medical doctors in the scene who took the time to edit Healthy Breast
Bondage, giving me valuable suggestions. If you have any questions
about the following material, please contact your doctor or consult the
Kink Aware Professionals list for a scene friendly referral:
http://www.bannon.com/~race/kap/


Fat Necrosis

Fat Necrosis is the destruction of fat cells in the breast due to trauma
(injury) or hypoxemia (deprivation of oxygen). Special care must be taken
with fatty breast tissue because the blood supply to fat is always poor.
Lack of oxygen or an inadequate blood supply causes the cells to die
and release particles of fat. The remaining tissue may become hard
or calcified. (1A)

The breast is not all fat, it also has supporting structures and milk ducts.
Other areas of the body have large fatty areas, such as the buttocks, which
can experience trauma-induced fat necrosis. However, the breasts are the
only largely-fat area that can be isolated and tied up, restricting necessary
blood supply.

Fat Necrosis mimics breast cancer both clinically and mammographically.
There is no way to tell a cancerous lump from fat necrosis without a biopsy,
so the lump must be surgically removed. (3, 16) Fat necrosis doesn’t cause
breast cancer, but you can’t assume that a lump in your breast was caused
by scarring - it must be removed in order to be sure it’s not cancer.

One woman reported that fatty tissue in her breast had been ruptured during
a minor car accident, in a line that was caused by her safety belt. The accident
had happened 4 years prior to her mammogram and had been so minor that
neither the cars or the people were hurt, and she had experienced no pain
and had no bruising. Yet the doctor explained that the milk ducts and supporting
structures in the breasts form scar tissue very easily. This makes the detection
of breast cancer more difficult. Since 1 in 9 women get breast cancer (some
doctors say 1 in 11) and early detection means the difference between life and
death, you must get regular mamograms and monthly breast exams to discover
any lumps in your breasts. (13)


Symptoms of Fat Necrosis:

1. The lumps are painless, round and firm, formed by the damaged and
disintegrating fatty tissues. (2)

2. The skin around the lumps can look red or bruised. (2)

3. The area may or may not be tender. (10)

4. One of the common symptoms of both fat necrosis and breast cancer is
dimpling in the breast. (17)

5. Severe scarring within the breast may cause nipple retraction. (11)

6. A clear liquid with a yellow or brownish color may drain from the nipple.(12)

7. Large breasts have more of a tendency to form fat necrosis when traumatized
than smaller breasts. (1A)


Prevention:

Trauma, which is a blow to the fat tissue, can occur under a variety of
circumstances. The degree of injury depends on the force of the blow and its
direction. Trauma can also be caused by twisting the tissue, which may
happen when rope is being wound around the breast. (18) Pain is probably
the best indicator that damage is being done.

Hypoxemia, too little oxygen in the blood caused by poor circulation, is a

leading cause of cell death and fat necrosis. (12) The point of no return is
difficult to define at the level of the cell. On the most basic medical level, the
point of irreversible damage in fat cells occurs in as little as 15-60 minutes. (11)

However, recognizable morphologic changes may not be apparent for a few

hours. It requires 8 to 24 hours for the nuclear changes to occur. Meanwhile,
the cytoplasm has passed through the stages of swelling and becomes
transformed into an acidophilic, granular, opaque mass. (11)

Since it’s difficult to tell by observation alone when the "point of no return"
has been hit, a reasonable rule of thumb is: with tight bondage (ie. a finger
can’t easily be inserted between the flesh and the rope) leave the rope tied
for less than 15 minutes. Then fully release the rope to allow the blood to
re-oxygenate the fat tissue (this may take ten to fifteen minutes because
the blood supply to fat is very poor.)(1A)

Trevor Jacques in "On the Safe Edge" recommends that you should always
able to put a finger between the rope and the skin to prevent cutting off the
circulation during bondage. (20) If the rope is loose enough to insert one
index finger to the knuckle (your choice, male or female finger!) then you
should be able to safely leave the rope on for 30 minutes. (19)

If the rope is loose enough for two or three fingers, you can go up to 45
minutes. It’s best not to tie the breasts for more than an hour before releasing
the rope to allow thorough circulation to occur. (11)

1/4 inch rope and up is usually recommended for any type of bondage where
the rope touches the skin. Pat Califia advises in "Sensuous Magic" that
narrower material than 1/4 inch (like string or cord) shouldn’t be used because
it can cut the skin. (21) Race Bannon in "Learning the Ropes" reminds us that
breathing should never be restricted by rope, so ask the bottom take a deep
breath before tying the anchor rope around her chest. (22)

Most leather-s/m technique books advise against suspending a body with rope.

Ideally, if rope is to be used for suspension, a web is created so the body is
supported in numerous places and care should be given so the knots don't put
pressure on the skin. Thus, it is not possible to safely suspend someone from
their breasts. The cut-off in circulation is exponentially higher because of the
added weight of the body during suspension, and there is a significant potential
for damaging the fragile supporting structures and the milk ducts of the breasts.


Hematoma

A hematoma is a swelling filled with blood that is caused by trauma. Hematoma
can cause scarring in the breast.(1A, 3) A small hematoma usually absorbs on
its own but a large one requires surgery.

Hematoma most commonly form when the skin has been broken. A hematoma is
an excellent medium for the growth of bacteria.(1) The inflammatory response
results from traumatic rupture of adipocytes which release their contents, often
followed by fat necrosis that causes scar formation. (9)

Symptoms of Hematoma:

1. Bruising or contusion is followed by swelling caused by the passage of fluid
through the walls of damage capillaries. (18)

2. Bacteria can cause infected fat tissue to appear black because of deposits
of iron sulfate from the degraded hemoglobin. (8)

3. You may have a fever as a sign of infection. (1)

Prevention:

A hematoma is usually caused by broken skin, yet it is possible for a blow to
cause a hematoma. Like fat necrosis due to trauma, the degree of injury depends
on the force of the blow and its direction. A hematoma can also be caused by
twisting the tissue, which may happen when rope is being wound around the
breast. (18) Pain is probably the best indicator that damage is being done.


Fibrocystic Breast Disease

Fibrocystic breasts are prone to the formation of both fluid-filled cysts and
fibrous tissue. Typically the breasts have a lumpy feel, and both lumpiness
and tenderness increase in the week prior to menstruation. Tight, frequent
breast bondage or long painful stimulation should be avoided, as these can
increase the formation of breast cysts. (6)


Fibroadenomas

Fibroadenomas are benign breast growths which usually occur in young
women. They are a very common cause of breast masses in the 15 to 25
age group. Fibroadenomas also account for 15% of all palpable breast
masses in women 30-40 years of age. Clinically, these growths are smooth,
firm and easily movable masses. It is generally accepted practice that suspected
fibroadenomas should be removed in women over the age of 25. These growths
are not associated with an increased risk of breast cancer. (15)


Breast Cancer

Breast cancer is a complex and devastating disease, and the most frequently
diagnosed cancer in American women. In 1995, there will be an estimated
182,000 new cases of breast cancer diagnosed in this country and an estimated
46,000 deaths. The cause of cancer is not known at this time. (5)

Fibrocystic breast disease, fibroadenoma, fat necrosis and hematoma are all
benign breast conditions that may lead to biopsy due to the fact that cancers
cannot be identified by palpation alone. (7) That's why it is common sense to
get anything usual checked immediately by a doctor. If it isn't cancer your mind
will be put at rest. If it is, it can be treated as quickly as possible.


Questions to Ask:

The following questionnaire was taken verbatim from "Breast Lumps, Cancer
& Self-Exam," 1996, by the American Institute of Preventive Medicine. (14) If
you answer yes to any of these questions, go see a doctor:

1. Do you see or feel any lumps, thickening or changes of any kind when you
examine your breasts? For example, is there dimpling, puckering, retraction
of the skin or change in the shape or contour of the breast?

2. Do you have breast pain or a constant tenderness that lasts throughout the
menstrual cycle? If you normally have lumpy breasts (already diagnosed as

being benign by your doctor), do you notice any new lumps or have any lumps
changed in size or are you concerned about having benign lumps?

3. Do the nipples become drawn into the chest or are they inverted totally,
change shape or become crusty from a discharge?

4. Is there any non-milky discharge when you squeeze the nipple of either
breast or both breasts?

5. Do you have a family history of breast cancer which leads you to be
concerned, even if you don’t notice any problems when you examine your
breasts?

6. Have you had recent trauma which resulted in a breast lump being formed?


Bibliography

1. Patrick Hudson MD PA, Plastic Surgery, 505/880 0779 or http://phudson.com/REDUCTION/complications(BR).html

1A. Fat necrosis after breast reduction;
http://phudson.com/REDUCTION/FAQ/fatnecrosis.html

2. National Cancer Institute (NCI),
http://www.healthtouch.com/level1/leaflets/nci/nci091.htm

3. http://www.trimaris.com/ussw/medical/lesions.html

4. Women's Diagnostic Cyber, Breast disfigurement,
http://www.wdxcyber.com/breast.htm#bskbg

5. The Cancer Information Service (CIS), a program of the National
Cancer Institute, 1*800*4*CANCER (1-800*422*6237).

6. FIBROCYSTIC BREAST DISEASE, What is It?
http://www.rxmed.com/illnesses/fibrocystic_breast_disease.html

7. Section: Letter of the Week, Heme/Onc, Ob/Gyn; Subject: Atypical
Cells on Breast Biopsy and Breast Cancer,
http://www.doctorjohn.com/content/obgyn/breastbiop.html

8. Carson DA, Riberio JM, Apoptosis and disease. Lancet (1993)
341:1252; Lane DP. A death in the life of p53. Nature (1993) 362:786;
Culotta E, Koshland DE. p53 sweeps through cancer research. Science
(1993)262:1958,
http://mbisg2.sbc.man.ac.uk/ugrad/biomedical/patholog/apop.html

9. © 1997 Applied Medical Informatics Inc.,
http://edcenter.med.cornell.edu/CUMC_PathNotes/Cell.Injury/Cell_Injury.html

10. Site concept and development - Orbis Broadcast Group, Interactive Media,
http://housecall.orbisnews.com/databases/ami/convert/001502.html#Causes,
+incidence,+and+risk+factors:

11. Principles of Drugs and Disease, PHAR 603; Team Leader: Richard Stull,
Ph.D., Cell Death, Autolysis, Necrosis,
http://www.su.edu/PHARMACY/PRIVATE/603/celldeath.htm

12. Cell injury and Adaption study notes;
http://worldmall.com/erf/andynote/cellinj.txt

13. Posted by Anoria on February 05, 1998 at 01:09:10, The Salon WWW Board,
http://www.ourhouse.org/wwwboard//wwwboard.htm

14. Breast Lumps, Cancer & Self-Exam, 1996, American Institute of Preventive
Medicine,
http://www.healthy.net/library/books/healthyself/womens/bcancer.htm

15. Long Island Breast Surgery, Information Center
http://www.huntingtonli.org/mishkit/benign.html

16. The Asean Journal of Radiology; 1995; 1:25-30,
http://www.chiangmai.ac.th/CMU/abstracts/abstract96/med11.html

17. Division of Plastic and Reconstructive Surgery, Emory University, Atlanta,
Ga., USA,
http://www.wcrf.org/uk/brochure/breast.htm

18. Encyclopedia Britannica, 1984 and 1997

Catalina

 

[catalina_francisco]

The Medical Realities of Breath Control Play

(http://members.aol.com/Oldrope/breath.htm)

(This is a copy of an essay that I have posted many times in internet newsgroups, particularly soc.subculture.bondage-bdsm)

Hi folks,

As many of you know, the subject of breath control play pops up here from time to time, and I often participate in the resultant threads.

I notice that I repeatedly tend to post the same basic information about the physiology of what's involved, and such "re-inventing the wheel" is unnecessary. I have therefore been working on a basic "position paper" of what's involved for some time, and here it is. Assuming that it's factually accurate (and I cordially invite _informed_ challenge on this point), this will become my "boilerplate" statement on the matter.

Given that "any subject can be written about at any length" it has been a distinct challenge to write this article. I have tried to keep it short enough so that people will actually read it, but also make it long enough to cover what I consider are the important points. I have tried to provide relevant physiological and biochemical information, but not go so deeply into detail that the average reader would get lost. I have tried to provide basic "starting point" references for my points and concerns for those who wish to research this matter further on their own (and I certainly encourage such research), but not to provide such an exhaustive list of citations that the researcher would become overwhelmed. Hopefully, my efforts have been at least adequate. My best wishes to all.

Regards,

Jay Wiseman

Copyright issues footnote: I wrote this article with the hope that it would be widely read and distributed, and without any particular expectation of financial compensation in return for writing it. Therefore, I consent to the following uses of this essay:

1. It's fine with me if you read it.

2. It's fine with me if you send it, in unaltered form and including the foreword, in private e-mail to approriate others.

3. It's fine with me if you post it, as mentioned in point # 2, to newsgroups and closed mailing lists.

4. If you put it up on a private, no-fee-to-access, website, please put it up as mentioned in point # 2 and include a link to the Greenery Press website (www.bigrock.com/~greenery).

5. I do require that you get my specific prior permission before putting this article up on a pay-to-access website, putting it in a book offered for sale, or otherwise charge for any sort of access to it.

########################################################################

The Medical Realities of Breath Control Play

Copyright 1997 by Jay Wiseman, author of "SM 101: A Realistic Introduction". All rights reserved.

For some time now, I have felt that the practices of suffocation and/or strangulation done in an erotic context (generically known as breath control play; more properly known as asphyxiophilia) were in fact far more dangerous than they are generally perceived to be.

As a person with years of medical education and experience, I know of no way whatsoever that either suffocation or strangulation can be done in a way that does not intrinsically put the recipient at risk of cardiac arrest. (There are also numerous additional risks; more on them later.)

Furthermore, and my *biggest* concern, I know of no reliable way to determine when such a cardiac arrest has become imminent.

Often the first detectable sign that an arrest is approaching is the arrest itself. Furthermore, if the recipient does arrest, the probability of resuscitating them, even with optimal CPR, is distinctly small. Thus the recipient is dead and their partner, if any, is in a very perilous legal situation. (The authorities could consider such deaths first-degree murders until proven otherwise, with the burden of such proof being on the defendant). There are also the real and major concerns of the surviving partner's own life-long remorse to having caused such a death, and the trauma to the friends and family members of both parties.

Some breath control fans say that what they do is acceptably safe because they do not take what they do up to the point of unconsciousness. I find this statement worrisome for two reasons:

(1) You can't really know when a person is about to go unconscious until they actually do so, thus it's extremely difficult to know where the actual point of unconsciousness is until you actually reach it.

(2) More importantly, unconsciousness is a *symptom*, not a condition in and of itself. It has numerous underlying causes ranging from simple fainting to cardiac arrest, and which of these will cause the unconsciousness cannot be known in advance.

I have discussed my concerns regarding breath control with well over a dozen SM-positive physicians, and with numerous other SM-positive health professionals, and all share my concerns. We have discussed how breath control might be done in a way that is not life-threatening, and come up blank. We have discussed how the risk might be significantly reduced, and come up blank. We have discussed how it might be determined that an arrest is imminent, and come up blank.

Indeed, so far not one (repeat, not one) single physician, nurse, paramedic, chiropractor, physiologist, or other person with substantial training in how a human body works has been willing to step forth and teach a form of breath control play that they are willing to assert is acceptably safe -- i.e., does not put the recipient at imminent, unpredictable risk of dying. I believe this fact makes a major statement.

Other "edge play" topics such as suspension bondage, electricity play, cutting, piercing, branding, enemas, water sports, and scat play can and have been taught with reasonable safety, but not breath control play. Indeed, it seems that the more somebody knows about how a human body works, the more likely they are to caution people about how dangerous breath control is, and about how little can be done to reduce the degree of risk.

In many ways, oxygen is to the human body, and particularly to the heart and brain, what oil is to a car's engine. Indeed, there's a medical adage that goes "hypoxia (becoming dangerously low on oxygen) not only stops the motor, but also wrecks the engine." Therefore, asking how one can play safely with breath control is very similar to asking how one can drive a car safely while draining it of oil.

Some people tell the "mechanics" something like, "Well, I'm going to drain my car of oil anyway, and I'm not going to keep track of how low the oil level is getting while I'm driving my car, so tell me how to do this with as much safety as possible." (They may even add someting like "Hey, I always shut the engine off before it catches fire.") They then get frustrated when the mechanics scratch their heads and say that they don't know. They may even label such mechanics as "anti-education."

A bit about my background may help explain my concerns. I was an ambulance crewman for over eight years. I attended medical school for three years, and passed my four-year boards, (then ran out of money). I am a former member of the American Academy of Family Physicians and a former American Heart Association instructor in Advanced Cardiac Life Support. I have an extensive martial arts background that includes a first-degree black belt in Tae Kwon Do. My martial arts training included several months of judo that involved both my choking and being choked.

I have been an instructor in first aid, CPR, and various advanced emergency care techniques for over sixteen years. My students have included physicians, nurses, paramedics, police officers, fire fighters, wilderness emergency personnel, martial artists, and large numbers of ordinary citizens. I currently offer both basic and advanced first aid and CPR training to the SM community.

During my ambulance days, I responded to at least one call involving the death of a young teenage boy who died from autoerotic strangulation, and to several other calls where this was suspected but could not be confirmed. (Family members often "sanitize" such scenes before calling 911.) Additionally, I personally know two members of my local SM community who went to prison after their partners died during breath control play.

The primary danger of suffocation play is that it is not a condition that gets worse over time (regarding the heart, anyway, it does get worse over time regarding the brain). Rather, what happens is that the more the play is prolonged, the greater the odds that a cardiac arrest will occur. Sometimes even one minute of suffocation can cause this; sometimes even less.

Quick pathophysiology lesson # 1: When the heart gets low on oxygen, it starts to fire off "extra" pacemaker sites. These usually appear in the ventricles and are thus called premature ventricular contractions -- PVC's for short. If a PVC happens to fire off during the electrical repolarization phase of cardiac contraction (the dreaded "PVC on T" phenomenon, also sometimes called "R on T") it can kick the heart over into ventricular fibrillation -- a form of cardiac arrest. The lower the heart gets on oxygen, the more PVC's it generates, and the more vulnerable to their effect it becomes, thus hypoxia increases both the probability of a PVC-on-T occurring and of its causing a cardiac arrest.

When this will happen to a particular person in a particular session is simply not predictable. This is exactly where most of the medical people I have discussed this topic with "hit the wall." Virtually all medical folks know that PVC's are both life-threating and hard to detect unless the patient is hooked to a cardiac monitor. When medical folks discuss breath control play, the question quickly becomes: How can you tell when they start throwing PVC's? The answer is: You basically can't.

Quick pathophysiology lesson # 2: When breathing is restricted, the body cannot eliminate carbon dioxide as it should, and the amount of carbon dioxide in the blood increases. Carbon dioxide (CO2) and water (H2O) exist in equilibrium with what's called carbonic acid (H2CO3) in a reaction catalyzed by an enzyme called carbonic anhydrase. (Sorry, but I can't do subscripts in this program.)

Thus: CO2 + H2O H2CO3

A molecule of carbonic acid dissociates on its own into a molecule of what's called bicarbonate (HCO3-) and an (acidic) hydrogen ion. (H+)

Thus: H2CO3 <> HCO3- and H+

Thus the overall pattern is:

H2O + CO2 <> H2CO3 <> HCO3- + H+

Therefore, if breathing is restricted, CO2 builds up and the reaction shifts to the right in an attempt to balance things out, ultimately making the blood more acidic and thus decreasing its pH. This is called respiratory acidosis. (If the patient hyperventilates, they "blow off CO2" and the reaction shifts to the left, thus increasing the pH. This is called respiratory alkalosis, and has its own dangers.)

Quick pathophysiology lesson # 3:

Again, if breathing is restricted, not only does carbon dioxide have a hard time getting out, but oxygen also has a hard time getting in. A molecule of glucose (C6H12O6) breaks down within the cell by a process called glycolysis into two molecules of pyruvate, thus creating a small amount of ATP for the body to use as energy. Under normal circumstances, pyruvate quickly combines with oxygen to produce a much larger amount of ATP. However, if there's not enough oxygen to properly metabolize the pyruvate, it is converted into lactic acid and produces one form of what's called a metabolic acidosis.

As you can see, either a build-up in the blood of carbon dioxide or a decrease in the blood of oxygen will cause the pH of the blood to fall. If both occur at the same time, as they do in cases of suffocation, the pH of the blood will plummet to life-threatening levels within a very few minutes. The pH of normal human blood is in the 7.35 to 7.45 range (slightly alkaline). A pH falling to 6.9 (or raising to 7.8) is "incompatible with life."

Past experience, either with others or with that same person, is not particularly useful. Carefully watching their level of consciousness, skin color, and pulse rate is of only limited value. Even hooking the bottom up to both a pulse oximeter and a cardiac monitor (assuming you had either piece of equipment, and they're not cheap) would be of only limited additional value.

While an experienced clinician can sometimes detect PVC's by feeling the patient's pulse, in reality the only reliable way to detect them is to hook the patient up to a cardiac monitor. The problem is that each PVC is potentially lethal, particularly if the heart is low on oxygen. Even if you "ease up" on the bottom immediately, there's no telling when the PVC's will stop. They could stop almost at once, or they could continue for hours.

In addition to the primary danger of cardiac arrest, there is good evidence to document that there is a very real risk of cumulative brain damage if the practice is repeated often enough. In particular, laboratory studies of repeated brief interruption of blood flow to the brains of animals and studies of people with what's called "sleep apnea syndrome" (in which they stop breathing for up to two minutes while sleeping) document that cumulative brain damage does occur in such cases.

There are many documented additional dangers. These include, but are _not_ limited to: rupture of the windpipe, fracture of the larynx, damage to the blood vessels in the neck, dislodging a fatty plaque in a neck artery which then travels to the brain and causes a stroke, damage to the cervical spine, seizures, airway obstruction by the tongue, and aspiration of vomitus. Additionally, there are documented cases in which the recipient appeared to fully recover but was found dead several hours later.

The American Psychiatric Association estimates a death rate of one person per year per million of population -- thus about 250 deaths last year in the U.S. Law enforcement estimates go as much as four times higher. Most such deaths occur during solo play, however there are many documented cases of deaths that occurred during play with a partner. It should be noted that the presence of a partner does nothing to limit the primary danger, and does little or nothing to limit most of the secondary dangers.

Some people teach that choking can be safely done if pressure on the windpipe is avoided. Their belief is that pressing on the arteries leading to the brain while avoiding pressure on the windpipe can safely cause unconsciousness. The reality, unfortunately, is that pressing on the carotid arteries, _exactly_ as they recommend, presses on baroreceptors known as the carotid sinus bodies. These bodies then cause vasodilation in the brain, thus there is not enough blood to perfuse the brain and the recipient loses consciousness. However, that's not the whole story.

Unfortunately, a message is also sent to the main pacemaker of the heart, via the vagus nerve, to decrease the rate and force of the heartbeat. Most of the time, under strong vagal influence, the rate and force of the heartbeat decreases by one third. However, every now and then, the rate and force decreases to zero and the bottom "flatlines" into asystole -- another, and more difficult to treat, form of cardiac arrest. There is no way to tell whether or not this will happen in any particular instance, or how quickly. There are many documented cases of as little as five seconds of choking causing a vagal-outflow-induced cardiac arrest.

For the reason cited above, many police departments have now either entirely banned the use of choke holds or have reclassified them as a form of deadly force. Indeed, a local CHP officer recently had a $250,000 judgment brought against him after a nonviolent suspect died while being choked by him.

Finally, as a CPR instructor myself, I want to caution that knowing CPR does little to make the risk of death from breath control play significantly smaller. While CPR can and should be done, understand that the probability of success is likely to be less than 10%.

I'm not going to state that breath control is something that nobody should ever do under any circumstances. I have no problem with informed, freely consenting people taking any degree of risk they wish. I am going to state that there is a great deal of ignorance regarding what actually happens to a body when it's suffocated or strangled, and that the actual degree of risk associated with these practices is far greater than most people believe.

I have noticed that, when people are educated regarding the severity and unpredictability of the risks, fewer and fewer choose to play in this area, and those who do continue tend to play less often. I also notice that, because of its severe and unpredictable risks, more and more SM party-givers are banning any form of breath control play at their events.

If you'd like to look into this matter further, here are some references to get you started:

"Emergency Care in the Streets" by Caroline (I'd recommend starting here.)

"Medical Physiology" by Guyton

"The Pathologic Basis of Disease" by Robbins

"Textbook of Advanced Cardiac Life Support" by American Heart Association

"The Physiology Coloring Book" by Kapit, Macey, and Meisami

"Forensic Pathology" by DeMaio and Demaio

"Autoerotic Fatalities" by Hazelwood

"Melloni's Illustrated Medical Dictionary" by Dox, Melloni, and Eisner

People with questions or comments can contact me at www.bigrock.com/~greenery or
write to me at Greenery Press, 3739 Balboa # 195, San Francisco, CA 94121.

Regards,

Jay Wiseman

 

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Breath Control: Is Epinephrine The "Smoking Gun"?

(http://members.aol.com/Oldrope/breath2.htm)

(The following essay was originally published, if I remember correctly, on the internet newsgroup soc.subculture.bondage-bdsm in May of 1998.)


Hi folks,

I want to share a new thought that I've recently had on this topic. I haven't got much time just now, so this will be brief and preliminary, but I think I just may have a new insight on this matter.

There are five basic categories of people who get choked. (I'll skip suffocation play for now.)

1. People being criminally assaulted.

2. People being arrested by the cops.

3. Martial artists.

4. People doing erotic choking on their partner.

5. People doing erotic choking on themselves.

Most of the people in group # 5 seem to die because they pass out while the noose is still constricting their necks.

Let's set aside group number 4 for the moment, and look at groups 1, 2, and 3.

_Lots_ of documented deaths

from even brief periods of strangulation in groups 1 and 2. _No_ reported deaths in group number 3. (Actually, one death in group 3, but even I will agree that one was due to a high dose of hubris.)

So what's the difference?

I don't believe that it's the technique, as is sometimes claimed. Indeed, I still think that the technique, even or perhaps especially when done properly, is a major contributing factor.

What is the essence of the difference between situations 1 and 2, and situation 3?

Try this thought out: Situations 1 and 2 are "real" while situation 3 is "play." A person being choked "for real" is likely to have a far different, and far stronger, fear/anger-type emotional response than a person in situation 3.

In particular, a person in a "real" situation such as 1 or 2 is likely to have a much stronger "flight or fight" response than a person in situation 3 -- and that means that they likely pump a lot more epinephrine (aka adrenalin) into their system.

Small doses of epinephrine strengthen the rate and force of cardiac contraction. Large doses of epinephrine also do the above, but also make the heart more susceptible to sudden, lethal arrythmias such as ventricular fibrillation -- and greatly increase its need for oxygen. (This sudden dumping of a large amount of epinephrine onto the heart can and does occasionally stop it. It's a large part of the reason why someone occasionally "dies of fright.")

There are a large number of documented cases of someone dying suddenly from "merely" having a gun pointed at them or having a "real world" criminal assailant "merely" reach their hands towards the victim's neck. No physical contact at all was involved, yet the person went into cardiac arrest almost immediately. It seems to me that such deaths can quite reasonably be called "epinephrine deaths."

We know that a "proper" choke causes a substantial amount of vagal outflow onto the heart, slowing its rate and weakening its force. The question emerges: Is it plausible that the same amount of vagal outflow onto an "epinephrine-drenched" heart (assault/arrest situations) would cause that heart to be considerably more likely to flop over into ventricular fibrillation than a "non-epinehprine-drenched" heart (martial artists)? IMO, hell, yes! The relevant physiology and pharmacology strongly support such an assertion.

Interestingly enough, _IF_ this line of reasoning is correct, then it would follow that SM-related "play" choking would be a relatively safe activity _compared_to_ the more "real" chokings of actual arrests and criminal assaults.

I dunno yet what to make of this, and I certainly wouldn't want anyone to take this as my final word on the subject or as an endorsement of strangulation play. (Among other things, there are a number of other dangers that I haven't mentioned here.) As I said, these are preliminary musings, not carefully thought out statements. Still, on the question of why is there is such a strong disparity in the deaths rates, little ol' Jay just may be on to something here.

Regards,

Jay Wiseman

(This follow-up post to the "Smoking Gun" essay was posted, if I remember correctly, to the internet newsgroup soc.subculture.bondage-bdsm in August of 1998.)


More On The "Smoking Gun"

( http://members.aol.com/Oldrope/breath3.htm )

Hi folks,

"In our last episode" [grin] of discussion on this subject, I made a post to the general effect that possibly the difference between fatal and non-fatal chokings had something to do with the relative levels of catecholamines in the systemic circulation of the victim. I'm making this as a follow-up post to that one. I'm not trying to start a flame war or anything like that. It's just that I'm aware that a number of people put the "smoking gun" essay on their web pages and stuff like that, and I'd therefore like them to include this essay as well.

Brief review of terms: The sympathetic aspect of the autonomic nervous system puts out the catecholamines called epinephrine and norepinephrine (the "fight or flight" response) and these chemicals, among other things, speed up the heartbeat. The parasympathetic nervous system puts out a chemical called acetylcholine (the "feed and breed" response) and this chemical, among other things, slows down the heartbeat. Fear or anger can cause sympathetic outflow. Sexual arousal, eating (and, interestingly enough, being choked) can cause parasympathetic outflow.

Basically, my hypothesis was that high levels of catecholamines significantly predisposed the heart to fatal arrythmias, and people who were "really" being assaulted/choked/etc. (people being choked by cops/criminals/etc.) presumably had significantly higher levels of catecholamines than people who were "not really" being assaulted/choked/etc (people being choked by martials artists during a match).

In other words, high levels of both sympathetic and parasympathetic stimulation, at the same time, significantly increased the risk of a cardiac arrest as opposed to high levels of either sympathetic or parasympathetic stimulation alone.

Therefore one had a plausible explanation regarding the difference in death rate between the two groups, and _possibly_ reason to believe that most BDSM play fell into the "not really being choked" category.

(I have to tell you that I've been somewhat nervous about the conclusions, and the behavior, that could result from my previous post. I believe that I now have some empathy with the people who said that oral sex was a "relatively low risk" behavior in terms of transmitting HIV. Yeah, the data probably supports that conclusion, but what does one say to the family and friends of the "exceptional" person who gets it anyway. Hell, for that matter, what does one say to the "expectional" person themself?)

Anyway, while I still like this hypothesis, I definitely don't feel that it's an all-inclusive explanation and I've felt the need to make a follow-up post.

In particular, there are a very large number of cases in which "purely" parasympathetic outflow is what appears to be what stopped the heart. The most common examples of this seem to be people who suffer a cardiac arrest while having a bowel movement. These are mostly people over 50 with a prior history of heart disease who arrest while engaged in heavy straining during a bowel movement. (This is one example of what's called a Valsalva Maneuver -- a term which I think anybody doing breath control play should be able to define.)

Such people are often put on laxatives and stool softeners by their physicians, and advised to "never hold your breath during a bowel movement" for just this reason. (By the way, this type of heavy straining can also sometimes cause a cerebral hemorrhage.)

In any event, we see that there is reason to believe that "purely" parasympathetic outflow can cause such an arrest. This risk seems to be especially higher in "older, sicker" people but I can't conclude that it's non-existent in younger people. (I do admit that it's stastically lower, although how low it would be for a given person on a given day is impossible to know in advance.)

I've also made two posts in another forum that contained some academic citations, so I thought I'd pass (a lightly edited version of) them along:

(copy-and-paste post # 1)

Hi folks,

I have some new information regarding breath control play.

Some of you may remember that I have noted in the past that there seems to be considerably more information on exceptionally quick, sudden deaths from choking or suffocation in the British forensic pathology literature than there is in the American literature (perhaps because they seem to lose more politicians from it than we do [grin]), and once more we have heard from our friends across the big pond.

There is a newly published forensic pathology textbook: "Simpson's Forensic Medicine" (11th edition. ISBN # 0340 61370X) by B. Knight -- a physician and a distinguished expert in the field of forensic pathology. He has quite a bit to say in the chapter on asphyxiation, particularly on the matter I have expressed so much concern about: vaso-vagal-induced sudden cardiac arrest secondary to only a few seconds of choking.

Dr. Knight states, in so many words, on page 89: "Choking can lead to a rapid, silent death from vaso-vagal cardiac arrest." He goes on to discuss this in much greater depth on pages 90-92. Furthermore, he notes earlier in the chapter, on page 77, at least two case reports of people who died this way secondary to brief self-strangulation with their own bare hands.

I hope the above will be regarded as credible supportive evidence of my concerns.

Regards,

Jay

(copy-and-paste post # 2)

[question # 1]

Someone asked: However, do you think the British study may be revealing cases of Sudden cardiac death due to ventricular tachy-dysrrhythmias, secondary to the changes in vagal tone? And perhaps they were not well versed enough in cardiac electrophysiology (the study of abnormal heart rrhythms)to recognize the connection?

I replied: I have read very substantial amounts of both British and American forensic pathology literature (and, for that matter, literature from many other countries as well), and I have detected no reason whatsoever to conclude that the British are anything but 100% up to speed on their cardiac electrophysiology -- and on all other aspects of medicine. The only difference seems to be that one finds more case reports of this type of incident in the British literature. (American forensic pathology literature, on the other hand, devotes a lot of space to serial killers.) Certainly the vaso-vagal-induced cardiac arrest syndrome -- cardiac arrest caused by only a few seconds of choking -- is also well-known to American forensic pathologists; see "Forensic Pathology" by DeMaio and DeMaio for starters.

[question # 2]

Someone also asked: If this is the case, is it possible , those who might be effected negatively by this type of "Breath control" play, are those who have a strong predisposition to sudden death anyway?

I replied: This has been a subject of some study. The article "Death from Law Enforcement Choke Holds" (American Journal of Forensic Medicine and Pathology, Volume 3, Number 3, September 1982, pages 253-258) outlines five types of persons who are believed to be of above average risk, but cautions that the risk is never non-existent. There are all-too-many case reports of people who were apparently in excellent health (and in none of the categories listed below) and yet suffered a sudden death due to only brief periods of choking anyway.

Just so you know, the five populations deemed by the authors to be of above-average risk are:

1. Men over age 40.

2. Persons with a history of a seizure disorder.

3. Mentally disturbed persons, particularly the manic-depressive while in the manic phase.

4. Persons using street drugs and alcohol.

5. Persons taking prescription drugs, particularly digitalis preparations and tricyclic antidepressants.

The article goes on to say: "Use of neck holds must be viewed in the same way as use of firearms; the potential for a fatal outcome is present each time a neck hold is applied and each time a firearm is drawn from its holster. The neck hold differs in that its fatal consequence can be totally unpredictable."

The article concludes: "Any law enforcement agency who prescribes to the policy of using the carotid sleeper should have frequent reinstruction in its use and continued reinforcement of the potential fatal results. No officer should be lulled into the false confidence that squeezing an arm about the neck is a safe and innocuous technique of subduing a suspect. It must be viewed as a potentially fatal tactic and reserved to situations which merit its risk."

Regards,

Jay

(end of copy-and-paste # 2)

OK, I just wanted to throw those citations out there. As you can see, they help (at least a bit, I hope!) in defining some of the "higher-risk" populations regarding strangulation.

Regards,

Jay

 

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Cumulative Brain Damage From Breath Control?

( http://members.aol.com/oldrope/cumdamg.htm )

On January 5, 1996, I published the following essay on the internet newsgroup Alt.Sex.Bondage (ASB) on the possibility of cumulative brain damage from repeated episodes on suffocation and/or strangulation.

Hi Mary, Phillip, et al.,

As has been prominently pointed out, in my latest post regarding the risks of breath control play I mentioned a concern that I had not raised in my previous posts: That there is hypoxia-induced _cumulative_ brain damage associated with strangulation and/or suffocation even if no major primary or secondary complication occurs. Several people, understandably, asked me how I "really knew" that took place.

Well, truth be told, I didn't, directly, know that it was true. I *did* have pretty good reason to believe that it was true. After all, two M.D. Neurologists and a PhD Neurophysiologist had told me that cumulative damage occurred. Also, another SM friend had told me that he had been told by an Anesthesiologist that it occurred. So I had been advised, either directly or indirectly, by no fewer than four people with extensive professional training in how the nervous system functioned that cumulative damage occurred secondary to episodes of cerebral hypo-oxygenation.

Additionally, I knew that brain cells died if (among many other causes) the blood nourishing them got too low on sugar, or if its pH got too low or too high, or if there was physical trauma to them. (It's been known for ages that the blows to the head that take place in boxing, in addition to occasionally causing a fatal intra-cranial hemorrhage, kill neurons in goodly numbers.)

That was good enough for me, but was it good enough for a.s.b.? Har!

Still, the requests for documentation were not unreasonable, and I can see a world-class medical school from my bedroom window, so I got myself over to its library and spent the better part of a day searching for verifiable, scientific-quality, information to support or (God forbid!) refute my claim. It was, after all, possible that all four of these professionals had been wrong and I would have to issue a craven apology and retraction.

Well, thanks to a MEDLINE search on the keywords "cumulative cerebral ischemia," it didn't take me long to get several "hits." I photocopied the three that seemed the most relevant, and have summarized them below. Any comments of my own are contained within [].

Journal article # 1

"Judo as a possible cause of anoxic brain damage; A case report"

by Owens and Ghandiali

The Journal of Sports Medicine and Physical Fitness, December 1991

Abstract: The rules of judo provide for strangulation techniques in which the blood supply to the brain is blocked by pressure on the carotid arteries; such techniques produce anoxia and possible unconsciousness if the victim fails to submit. A case is presented of a patient with signs of anoxic brain damage, with psychometric investigations showing memory disturbance consistent with a left temporal lobe lesion. This patient had been frequently strangled during his career as a judo player; it is suggested that such frequent strangulation was the cause of the damage. Such an observation indicates the need for caution in the use of such techniques.

A few quotes from the article:

"The patient was a 33-year-old male international class judo expert who was admitted as an emergency following a sudden loss of consciousness followed by definite left hemiparesis, confusion, and amnesia. Power returned quickly to the left arm and leg but his memory remained poor; during the six weeks prior to his admission he had apparently suffered episodes of altered awareness and occasional loss of consciousness. Skull X-ray was normal and a subsequent CAT scan revealed no evidence of abnormality. He was discharged with a diagnosis of suspected anoxic brain damage but following repeated fainting episodes and persisting difficulties with memory over the following months, he returned for further assessment."

"It was concluded that anoxia resulting from his judo experiences had resulted in the lesion and he was discharged with instructions to cease his participation in the sport."

"Anoxic brain damage is not a common form of sports injury but the unique characteristics of judo suggest that under certain circumstances a picture similar to that defined here may result from participation."

"In addition it should be noted that judo players are commonly strangled into unconsciousness during teaching either as an illustration of the effectiveness of the technique or in order to demonstrate the judo resuscitation procedures ("kuatsu"). Such circumstances do not, as far as we are aware, occur in any other sport. The present case had apparently been frequently strangled into unconsciousness during his judo career and it was surmised that the cumulative effect of such strangulation had been, at least in part, the cause of the anoxic brain damage. Whilst it is of course possible that some other factor was responsible, there was nothing in his detailed case history other than the judo to account for the sustained anoxia, which is of course rarely seen in a patient of such age. It may be appropriate therefore to recommend caution to judo players regarding such techniques."

Journal article # 2

"Neuronal damage following repeated brief ischemia in the gerbil"

by Kato, Kogure, and Nakano

Brain Research, 479 (1989)

Abstract: The effect of repetition of brief ischemia, which causes no morphological brain damage when given as a single insult, was studied. Two-minute forebrain ischemia was induced in gerbils singly and three or five times at 60-minute intervals. Although [a single incident of] two-minute ischemia induced no neuronal damage, three or five repeated ischemic insults caused neuronal damage in the selectively vulnerable regions, the severity being dependent on the number of episodes.

A few quotes from the article:

"Gerbils subjected to a single two-minute ischemia (n=5) revealed no abnormal calcium accumulation throughout the brain. In all animals subjected to three two-minute ischemic insults (n=5), abnormal calcium accumulation was shown in the CA1 sector of the hippocampus and the thalamus; there was also such abnormal calcium accumulation in the dorsolateral part of the striatum and the substantia nigra in 8 of 10 hemispheres, and in the inferior colliculus in 2 of 10 hemispheres. Gerbils subjected to five two-minute ischemic insults (n=4) revealed most severe calcium accumulation in the brain."

"Abnormal calcium accumulation shown by 45Ca-autoradiography has been reported to be equivalent to the sites of neuronal damage and is a useful tool for mapping the distribution."

"Gerbils subjected to a single two-minute ischemia (n=5) showed no neuronal damage throughout the brain. In animals killed four days after three 2-minute occlusions (n=4) the CA1 neurons had disappeared in all animals. Various degrees of neuronal injury were seen in the striatum and thalamus. In animals subjected to five 2-minute occlusions, the changes were generally more pronounced than in animals subjected to three 2-minute occlusions."

"The present study indicates that repeated ischemia causes brain injury depending on the number of episodes, even though no morphological brain damage results when the ischemia is induced as a single insult."

Journal article # 3

"Neuronal damage and calcium accumulation following repeated brief cerebral ischemia in the gerbil"

by Araki, Kato, and Kogure

Brain Research (528) 1990

Abstract: (Note: The abstract was presented as a single very long paragraph. I've broken it into several shorter paragraphs to improve readability.) We investigated the distribution of neuronal damage following brief cerebral transient ischemia and repeated ischemia at one-hour intervals in the gerbil, using light microscopy and 45Ca-autoradiography as a marker for detection of ischemic damage. The animals were allowed to survive for seven days after ischemia induced by bilateral carotid artery occlusion.

Following [a single instance of] two-minute ischemia, neuronal damage determined by abnormal calcium accumulation was not observed in the forebrain regions. Following [a single instance of] three-minute ischemia, however, abnormal calcium accumulation was recognized only in the hippocampal CA1 sector and part of the striatum.

Two 2-minute ischemic insults caused extensive abnormal calcium accumulation in the dorsolateral part of the striatum, the hippocampal CA1 sector, the thalamus, the substantia nigra, and the inferior colliculus. The ischemic results were more severe than that of a single three-minute ischemia. However, three 1-minute ischemic insults caused abnormal calcium accumulation only in the striatum. On the other hand, three 2-minute ischemic insults caused severe abnormal calcium accumulation in the brain. The abnormal accumulation was found in the dorsolateral part of the striatum, the hippocampal CA1 sector, the thalamus, the medial geniculate body, the substantia nigra, and the inferior colliculus. Gerbils subjected to three 3-minute ischemic insults revealed the most severe abnormal calcium accumulation.

Marked calcium accumulation was seen not only in the above sites, but also spread in the neocortex, the septum, and the hippocampal CA3 sector. Morphological study after transient or repeated ischemia indicated that the distribution and frequency of the neuronal damage was found in sites corresponding to most of the regions of abnormal calcium accumulation. The abnormal calcium accumulation, however, was not only found in the regions such as the neocortex and the hippocampal CA3 sector where the neuronal damage was seen.

The present study demonstrates that repeated ischemic insults at one-hour intervals can produce severe neuronal damage not only in the basal ganglia and the limbic system, but also in the brainstem. Furthermore, they suggest that the cumulative effects after repeated ischemic insults are related to the time of the ischemia or the number of episodes.

A few quotes from the article:

"The present study has demonstrated that brief but repeated forebrain ischemia in the gerbil can cause severe neuronal damage not only in the basal ganglia and the limbic system, but also in the brainstem."

"It is well known that certain regions such as the neocortex, hippocampus, striatum, thalamus, and cerebellum are selectively vulnerable. The present study also suggests that repeated ischemic insults can produce severe neuronal damage in selectively vulnerable regions when it is induced repeatedly at one-hour intervals. These patterns of neuronal damage after repeated ischemia are essentially the same as those following a single 10-15 minute ischemia in the gerbil, and the mechanisms of ischemic neuronal damage in repeated ischemia are partly the same as those in transient ischemia."

"The neuronal injury of the brainstem, therefore, may be due to excessive lactic acid accumulation."

"In conclusion, the present study indicates that repeated brief ischemic insults can cause severe neuronal damage not only in the basal ganglia and the limbic system but also in the brainstem. Furthermore, they suggest that the cumulative effect after repeated ischemic insults is related to the time of the ischemia and the number of episodes."

xxxxxxxxxx End of journal material xxxxxxxxxx

Please, folks, no gerbil jokes.

Regards,

Jay


I want my "Precaution B"!

( http://members.aol.com/Oldrope/precaub.htm )

(I wrote the following essay as part of an ongoing debate on breath control in a forum.)

Hi Les (et al).

My thanks to you -- and, of course, to the others -- for your kind words. For the record, the "heat" generated towards me (so far at least [grin]) is well within my ability to withstand. Among other things, after extensive debate and exchange of information, I have pretty much reached agreement with Michael Decker, who is very arguably this nation's leading teacher of and advocate for breath control -- more properly called axphyxiophilia -- so this is mostly a rehash for me. Still, that "kindling effect" post was interesting. I'll have to look more into that.

I think a lot of the frustration that emerges when breath control is discussed stems from the fact that most people have received their safety education largely in the context of preventing infectious disease transmission. Therefore people are used to hearing safety messages like "practice A is very risky, but precaution B reduces the risk a great deal; therefore, if you engage in practice A please also take precaution B." (Nowadays, precaution B is often, of course, use a condom.)

There are similar "precaution B" messages regarding bondage (not so tight that the limb goes numb), electricity play (not above the waist), and so forth. Thus, people are used to hearing a "precaution B" message in connection with a risky behavior.

Unfortunately, given the realities of the physiology of asphyxiophilia, there really is no meaningful "precaution B" that one can take. Yes, one can take a CPR class and, yes, one can "watch one's bottom carefully" (exactly what one will watch for, and exactly how one will interpret what one detects, is often left more than a bit vague -- truth is, it's virtually impossible to tell when cardiac arrest is imment by clinical assessment alone, even by someone highly trained and experienced) but nobody I know who really knows something about the physiology of asphyxiophilia believes that doing either of those things will _really_ do anything to significantly reduce the risk involved. Thus, we are left with the distinctly unusual (and unpopular) message that "practice A is very risky, and there is no significant precaution B, so lotsa luck if you try it" One can certainly understand how people could feel frustrated, and even cheated.

Unfortunately, about the only thing one could do that would be likely to really reduce the risk would be to equip one's playroom with a defibrillator and become highly skilled in its use and in the related skills. Last I heard, low-end defibs were costing about $4,000.00 -- so this is hardly an option for most of us. (Furthermore, defibrillators most definitely do not come with a guarantee of success regarding restarting a stopped heart.)

Asphyxiophilia is not just another kink. It is a qualitatively different practice, and plays by its own very stark, not-very-forgiving, and often counter-intuitive rules. You can venture onto its "turf" if you wish, but I'd suggest that you take along as detailed a map as you can get. (As a rough rule of thumb, the less you know about the details of the vagus nerve, the less qualified you are to do breath control play.) Once again, if you're going to try doing this, I very strongly urge you to read my "Medical Realities" essay.

Regards,

Jay Wiseman

"If you're gonna play the game, boy, you'd better learn to play it right." - "The Gambler" by Kenny Rogers

 

[Pure]

Great

very informative; glad you've bumped this.

pure
j.