British Medical Journal publishes paper titled "Sword swallowing and its side effects"

Read it here: http://www.pubmedcentral.nih.gov/article......=1761150

Abstract:

Objective: To evaluate information on the practice and associated ill effects of sword swallowing.

Design: Letters sent to sword swallowers requesting information on technique and complications.

Setting: Membership lists of the Sword Swallowers' Association International.

Participants: 110 sword swallowers from 16 countries.

Results: We had information from 46 sword swallowers. Major complications are more likely when the swallower is distracted or swallows multiple or unusual swords or when previous injury is present. Perforations mainly involve the oesophagus and usually have a good prognosis. Sore throats are common, particularly while the skill is being learnt or when performances are too frequent. Major gastrointestinal bleeding sometimes occurs, and occasional chest pains tend to be treated without medical advice. Sword swallowers without healthcare coverage expose themselves to financial as well as physical risk.

Conclusions: Sword swallowers run a higher risk of injury when they are distracted or adding embellishments to their performance, but injured performers have a better prognosis than patients who suffer iatrogenic perforation.

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Comment (from me ... NOT a scholar): [imitating Gomer Pyle's voice] "SURPRISE, SURPRISE, SURPRISE!"

Ain't it amazing how much we need the scientists to tell us what we know?

But statistics are such fun!...the art of asking the same question 50 different ways, just so you can perform acts of intellectual mast*rbation over the differences in the results.

What is "iatrogenic perforation"?

"Iatrogenic perforation" = doctor induced perforation....as when a doctor performs a procedure (like an endoscopy).

This is a perforation caused by a doctor. Usually during endoscopic procedures, and I don't see its application to this article. Anything "iatrogenic" is translated to "caused by medical professional" and encompasses drug interactions, secondary infections from treatments, or accidental damages caused from over a wide variety of medical treatments. The only thing I can think they are saying is that when a doctor accidentally perforates the esophagus, no one realizes it happens and they don't know to look for it, so it goes untreated. In the case of a sword swallower, they suspect a perforation, and know to look for it.

No sir (Montemagic):

There is an exact application to relate endoscopy to sword swallowing. It is nearly the same thing with the only difference being endoscopy is perfomed BY someone ON someone (with a medical instrument) while sword swallowing is performed by someone on themselves. So the comparison is valid, since they both involve ramming something down the esophagus.

"The only thing I can think they are saying is that when a doctor accidentally perforates the esophagus, no one realizes it happens and they don't know to look for it, so it goes untreated. In the case of a sword swallower, they suspect a perforation, and know to look for it."

Is exactly what the are NOT saying. What they are saying is that when physicians converted from straight, rigid metal instruments to soft, pliable instruments their rate of perforation dropped (duh). Furthermore, unlike sword swallowers--who are typically healthy individuals, patients who undergo endoscopy are usually older and have pre-existing disease (hence the reason for the patient having to undergo the procedure). This pre-existing disease likely contributes to the iatrogenic rate of perforation (people who have esophogeal cancer or infections, have soft, friable tissue which may perforate more easily). The perforation is usually recognized at the time of the injury (and is therefore treated in a timely fashion), but since the patient is sedated it isn't recognized until the endoscope is well outside of the esophagus.

Sword swallowers' injuries, on the other hand, are generally milder because the swallower (who is hopefully awake) is able to recognize when he/she is doing something wrong and stop what they are doing (unlike the sedated patient who has no control over his/her procedure and cannot tell anyone they are feeling pain, because they are out of it). Because of that, the perforations of sword swallowers are generally less severe (the hole isn't as large).

However, there is often a delay in seeking medical treatment by sword swallowers. Finally, the perforations in sword swallowers are usually in a different location than the perforations of patients who have undergone endoscopy.

I hope this clarifies.

Oh, yeah...I forgot to add:

Morbidity and mortality is multi-factorial...it isn't just the location of the hole or the size of the hole or when the injured party got treated. It is a combination of these factors.

Finally, they conclude basically by saying that sword swallowers have a high likelihood of having an injury, but the risk of having a life threatening injury is low and the prognosis of having an injury is better than if you had a perforation made for you by someone else (e.g. a doctor performing an endoscopy).

Thanks for clarifying, Doc. Even I myself got confused.

Any time!

I loved the article and thanks to Rossmacrae for posting it!

I echo his sentiment, "SURPRISE, SURPRISE, SURPRISE!" with regard to "Sword swallowers run a higher risk of injury when they are distracted or adding embellishments to their performance". However, it is somewhat surprising (to me anyway) that the injuries of the sword swallower generally have a reasonable good outcome. Esophageal perforations are ALL really bad.

Apparently, there is a transvestite sword swallower in town here, that has come to the hospital on multiple occasions with severe enough GI bleeding to require embolization (cutting off the blood supply to the bleeding artery by tracking a small catheter up from the artery of the leg to the arteries that supply the stomach and injecting a material to clog up the artery and keep it from bleeding). She has had several life threatening episodes, from what I hear. I haven't actually treated her since she has always gone to a different hospital--one more close to her own neighborhood, but since a lot of the docs in the area know I am into this stuff, I hear about it when it happens.

Ahhh I see what you are saying, thank you for clarifying.

One last clarification, the term "iatrogenic" does mean "physician induced" does it not?

Yes. Unfortunately, it does....

Thank you both for your info on your subject. You both rock.

Anton