Part 7

Possible long term health risks

There is simply not any information directly related to this play. Therefore, information from other sources about such things as sleep apnea, the valsalva maneuver, and general hypoxia have been studied.

I can say that long term brain damage is a risk of this play. Whenever the brain is without fresh oxygen or the oxygen level is lowered substantially there will be brain damage. This damage is fairly generalized. Depending on the duration and amount of oxygen in the blood the damage will be different. To my knowledge, there is no formula for determining an exact amount of damage per second of hypoxia or anoxia.

I can say that many people with long term sleep apnea (one of the most common health concerns) usually only experience slightly detectable brain damage over many years of struggling with apnea. To be categorized as someone with sleep apnea they must experience at least 10 apneas + hypopneas per hour of sleep. An “apnea” is defined as a cessation of airflow that lasts at least ten seconds. A hypopnea is defined as a significant reduction in airflow lasting at least ten seconds and usually associated with a decline in a person’s oxygen level.

The findings in such cases seem to suggest that some sleep apnea patients will perform worse on certain types of neurophsychological tests (especially those involving memory). They generally have complaints about their level of concentration and some are said to have undergone personality changes and have shorter tempers or depression. This may be attributed to brain damage, but there is no direct causality proven in the research I have seen. This all may just be attributed to poor quality of sleep the patients have. I have seen these very same symptoms appear in many studies of those experiencing sleep deprivation.

Therefore, while brain damage is certain whenever the brain experiences hypoxia or anoxia it has not been proven that noticeable brain damage has been noted in anyone due to breath control play involving lack of oxygen lasting under a minute (many apnea patients will experience apneas of this length). There have been some studies done on rats being deprived of oxygen for two minutes and then given air for half an hour before being deprived of air for two minutes again that resulted in heavy brain damage in the animals. I think that we could infer from this that repeatedly depriving someone of air till they faint and repeating the procedure over and over again is going to cause heavy brain damage. It is difficult to say, however, because people are a heck of a lot different from rats.

An important thing to know about the brain is that it does not grow new brain cells. Once you lose one, you lose it. Another important thing to understand is that the brain does not store oxygen as some of the other tissues in the body do. If your oxygen level is compromised, the damage starts close to immediately.

Now, I would like to add a little perspective. You lose brain cells all the time, our brain is set up so that we can endure a lot of brain damage without any real consequences. Drinking, drugs (even prescription drugs), aging, and many contact sports lead to regular brain damage. Once again, it is all a matter of being conscious of the risk and deciding what level of damage you are comfortable with. I happen to feel very comfortable with absences of oxygen that are under 30 seconds (but that is a personal choice).

I can tell you that it is always important to return a person to normal breathing if they are passing out from oxygen deprivation. I can tell you that anoxia is more dangerous than hypoxia. I can tell you that the longer the breath play continues the more damage will be done. I cannot tell you what is acceptable for you.

Heart and Lungs
There is simply not any information directly related to this play. Therefore, information from other sources about such things as sleep apnea, the valsalva maneuver, and general hypoxia have been studied. I have read many things that have stated that there are no long term effect on the heart or lungs. Almost all of the information below is extrapolated from studies on those with sleep apnea and thus they may be associated more with factors such as underactive thyroid gland, overactive pituitary gland (if it is secreting too much growth hormone), and obesity that is frequently seen in apnea patients. With that in mind here are some of the problems that are sometimes seen in sleep apnea patients:

High blood pressure (there is pretty good evidence of this).

Heart attack and stroke (there is very poor evidence of this).

Heart failure This is very rare and they usually experience marked swelling of their ankles and legs beforehand. Later they may experience some shortness of breath with exertion and or some swelling of their abdomen.

Heart arrhythmias (it is unlikely that apnea causes arrhythmias from the research I’ve read).

Respiratory (lung) failure This is extremely uncommon and only seen in the most severely affected apnea patients. Apnea patients who develop this usually experience some shortness of breath but usually they are unaware of the problem until the doctor does a blood test. If the body’s oxygen level is very low or the carbon dioxide level is too high then this tells the doctor that the body’s breathing system is not working properly and is starting to fail.

Common Injuries

The trachea is commonly known as the windpipe and is essentially a cartilaginous tube. Some people who practice breath control put pressure on the trachea during play. There are a few important injuries that can come of that.

The trachea can rupture. This will cause intense pain, gasping for air, and thick secretions in the throat. This is a medical emergency and proper medical care must be sought immediately.

Another less immediate condition that can occur is Tracheitis. It is an inflammation of the trachea. The signs of tracheitis are thick and purulent secretions of the throat, swelling, croupy cough, sore throat, and fever. This may seem minor at first and it may correct itself if the throat is rested and you use a humidifier to help with the secretions. This can ultimately turn deadly very quickly, however, and I would feel uncomfortable with only doing this. Usually a hospital will deal with this condition by administering humidified oxygen, suctioning the throat, giving antibiotics, and monitoring a person’s vital signs.

In either of these cases, there is always the possibility of an emergency tracheotomy and need for medical attention. This involves an incision that is made through the skin and muscles into the trachea to get air to the lungs. If you do a lot of play that involves pressure on the trachea, I would suggest you know how to perform an emergency tracheotomy.

I do not have information on whether repeated attempts of tracheal compression will weaken the trachea but I would personally recommend that if you are going to play in this way, you go about it with a slow even pressure. This is not something to do violently and it could easily get a bit rough in the heat of passion.

Larynx The larynx is the enlarged upper end of trachea below the root of the tongue. It is the organ of voice and consists of nine cartilages bound together by elastic membranes and moved by muscles. It is a very intricate structure and can be easily injured. Pressure to the larynx should always be avoided. Here are a few of the injuries that can occur.

A Fracture of the Larynx is an incredibly serious injury that needs immediate medical attention. Some signs of fracture or compression of larynx are loud breathing, choking and gasping respiration, weak and fast pulse, and blue skin. If left untreated, it will usually lead to death. It can also seriously effect the voice if a person does manage to survive the injury.

I would say that if you do any type of compression of the neck, it is important to do some research into emergency tracheotomy. If this type of injury occurs it will at least give your partner some chance of survival if the air is completely cut off with this injury.

The best way to avoid this injury is to learn where the larynx is and never do any form of play that places pressure upon it. If you practice some form of breath control that is going to press on the larynx, then at least apply it slowly and carefully and try to pad any apparatus that could be used around the neck. I really cannot stress enough how dangerous the consequences of this type of compression could be.

Laryngitis is also a complication of any form of compression of the larynx. It is essentially an inflammation of the larynx. Some symptoms of laryngitis are loss of voice, hoarseness, pain, and sometimes coughing.

It is usually harmless and doctors recommend that you rest your voice, take cough suppressants, and inhale steam. I would personally look into seeing a doctor for it just in case there is a slight fracture or other problem present causing the symptoms.

The best way to avoid this injury is to not put pressure on the larynx.

Blood Vessels
At times play puts stress on the blood vessels of the neck, especially the carotid arteries. This can cause several problems but I’m going to focus on dissection. There are two types, post-traumatic dissection and spontaneous. For our purposes, I will speak to the post-traumatic type.

Post-traumatic carotid dissection is essentially stretching and small tearing of the artery brought on by trauma such as strangulation.

The symptoms of this tearing are visual loss, weakness, numbness, or speech difficulties. These events may be transient or permanent.

The only treatment is to get to a doctor and have it evaluated. They usually test using MRI or angiography. If they find that you are suffering from it you will probably be given anticoagulation (blood thinning) drugs for a total of 8-12 weeks. They will also do repeated angiography before stopping treatment to ensure that the vessel has healed.

I think I should add some perspective about this injury. It most often occurs by people simply turning their head at the wrong time or by going to a chiropractor. It is a pretty common injury that doesn’t necessarily need a lot of stress to come about.

The best advice I can offer to avoid this injury is that if you do hanging, you should pad the noose. If you have your partner strangle you, they should apply pressure to your neck slowly and never twist the neck. Also, any bondage around the neck should be wide enough that it doesn’t dig into the flesh easily and twist against the skin…I’d say a good rule is to not use anything less than 1/2 inch wide. If I were going to use a ligature of some sort directly against the skin, it would be soft and lubricated with a dry lubricant such as baby powder. I would be careful not to apply so much dry lubricant that I ended up inhaling it, however. That wouldn’t be fun.

This could have gone under Blood Vessels but I thought it deserved separate attention. A stroke is basically a sudden loss of consciousness and paralysis caused by a hemorrhage into the brain, blockage of a blood vessel with a blood clot or foreign object, or a rupture of an artery in the brain.

Sometimes during strangulation play plaque (a fatty substance in the blood vessels) is dislodged. If that happens, it can lodge itself in the blood vessel and lead to a stroke.

Strokes are unfortunately very common in this society and a few symptoms of one are loss of consciousness, paralysis, unequal pupils (large one on side of stroke), paralysis usually on one side, sweating, slightly lowered temperature, and speech disturbances.

I would think that a person would be more prone to stroke if they have had one before, they have a history of heart or blood pressure problems, they are overweight, in poor physical condition, or they have a cholesterol problem.

If your partner has a stroke, they need immediate medical attention. While you wait for the ambulance, you can help them in a couple of ways. Handle them very carefully, especially their paralyzed parts. Keep them lying on their back, head and shoulders slightly raised. Turn the person’s face carefully to the side if they are having a hard time breathing. That will let the secretions drain out. If they have anything in their mouths, remove it. Keep them warm and quiet but don’t overheat them. Do not move your partner more than necessary. Do not use any stimulants or smelling salts. The person may be unconscious but able to hear what you say…so don’t say things to panic them. Don’t try to give them anything to drink or eat.

Some things that may help you to avoid this problem are regular aerobic activity and good diet (if you like to bottom to strangulation). It is important that if you bottom to this sort of play you get regular physicals that evaluate your general health. If you have a risk factor such as high cholesterol, then perhaps avoid strangulation play. If you do strangulation play, be sure that pressure is applied slowly and that no twisting occurs. If you lessen the trauma to the vessel, you lessen the risk of dislodging something. Do whatever you can to avoid trauma to the vessels.

Spine The cervical spine is made up of the first 7 bones of the spinal column. There are several things that can happen to injure this area. I will cover a couple of them.

A Fracture in the Cervical Spine will usually cause pain, possible paralysis, fainting, and suppression of reflexes.

A pinched nerve in the area of the cervical spine will mimic a lot of the symptoms of a fracture and is also very serious. In the long term, if left untreated, it can cause constant pain and loss of muscle tone.

The most important thing to do in the case of spinal injury is to make sure the person does not move. Calm them and tell them to lay still while you call for medical assistance. It is important to reassure them that everything will be well as long as they do not move around.

The treatment of these injuries usually involves putting a person in some form of traction so they will not move while the bone(s) are healing. In the case of a nerve being pinched, it is possible that surgery will be needed.

There are several things you can do to avoid this injury. The first being that if you are involved in hanging with your feet off the floor (or being an “airwalker”), it is important that you do not allow yourself to drop into position. That can lead to serious spinal injury even if the drop is as little as an inch. Remember, hanging was originally not used to strangle someone but instead used to break their neck. Any ligature is going to be more likely to cause a spinal injury, especially if it is a thin one. Another risk is if you apply a police style choke hold when your bottom is struggling or if you twist the neck slightly while applying it. It is very easy to cause injury that way.

Seizures and Fainting
Seizures and Fainting take similar first aid so they will be described together.

Seizures fall into three categories.

    • Grand Mal seizures involve a sudden loss of consciousness followed by board like rigidity that changes to jerking muscle movements that gradually disappear. The victim usually wants to sleep afterwards. When they awake, they are usually cranky and have no memory of the seizure. There may be incoherent speech, extreme restlessness, and confusion.
    • Petit Mal seizures last about five to twenty-five seconds. You will usually notice the person’s skin go a bit pale and also notice them begin stare off into space. The eyes may roll back and the head, eyes and upper extremities may jerk slightly. The victim is usually alert right afterwards and able to function normally.
  • Psychomotor seizures include automatic stereotyped movements of the body combined with partial amnesia. The victim may become angry and act out or have a temper tantrum after experiencing it.

Whatever seizure a person experiences, they may find that they have a strange feeling, smell, pain, or visions beforehand that signal the beginning of an attack.

Fainting is a sudden loss of consciousness due to insufficient supply of oxygenated blood to the brain. It is also common to faint out of an emotional response to something unpleasant or scary. Fainting is more common as you get older.

A few things that you may notice in someone before they faint are weakness, dizziness, paleness, sweating, and cold skin. The victim may notice spots before the eyes, numbness, tingling of extremities, nausea, disturbances of vision, shallow breathing (in our case…sometimes no breathing *wicked grin*), and a feeling of lightheadedness. The pulse is usually rapid and weak.

Both of these conditions in and of themselves are not considered medical emergencies and both are treated similarly.

If your partner faints or seizures, be sure to make sure they don’t fall and harm themselves. Keep calm. There is no way you can stop a seizure. Do not forcefully restrain your partner and loosen any clothing or restraints that may limit their circulation. Make sure that they have an open airway. In the case of a seizure, you might place a pillow under your partner’s head so they don’t hurt themselves. In the case of fainting, elevate the legs so that the head is lower than the feet. If you can, you might want to gently turn their head to the side so they don’t choke on saliva or vomit. Sometimes in the case of a seizure, a person will stop breathing. Monitor your partner’s condition carefully and make sure that you follow up with first aid for any secondary situation that might arise.

There is very little we can do to avoid these things and still play like we enjoy. The important thing is how we handle it after it happens. You need to restore air as soon as possible when a person faints or seizures and give them proper first aid. The main cause of death involving breath play is that someone is playing by themselves and faints or seizures while unable to remove the device restricting their air.

Airway Obstruction by the Tongue
A simple thing to overlook is that if your partner passes out their tongue might fall back in their throat and continue to suffocate them.

If your partner passes out, you can prevent this problem by tilting your partner’s head, chin pointing up. Place one hand under the person’s neck and gently lift while pushing with one hand on the victim’s forehead. This should move the tongue away from the back of the throat and clear the airway

Aspiration of vomitus, mucus, or saliva
Sometimes a person can inhale his or her own vomit, mucus, or saliva. This is very dangerous.

Usually a person will not actually draw the materials completely into the lungs. The symptoms of aspiration of foreign materials is coughing, unconsciousness, cyanosis, cardiac arrest, and cessation of breathing.

If the person begins to develop a problem the very first thing to do is to position them so they can vomit and keep an open airway. Remove all gags or bondage immediately. Sometimes the Heimlich maneuver can help to clear their airway if something is lodged within it. If they are coughing, make sure to monitor them while you get emergency medical attention. I do not have enough information yet on what else might be helpful. I have heard that some people have successfully helped in this situation by plugging the victim’s nose and using their own mouths to suction the airway.

There are some things that will probably lower your risk of having this happen in play. Do not gag the person you are choking. If you do gag them, have a way to release the gag in a second (literally). Do not put the bottom into such tight bondage that you couldn’t turn them to the side if they needed to throw up. Don’t play with someone when they have a head cold. If you have a partner who gets nauseous during play it may be a good idea to stick to shorter times of asphyxiation.