The Medical Realities of BDSM Breath Control Play – Part 2

BDSM Breath Control Play

This is Part 2 of the article The Medical Realities of BDSM Breath Control Play. Read Part 1 here.

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-threatening 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 <carbonic anhydrase> 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 to 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-outlfow-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 BDSM party-givers are banning any form of breath control play at their events.

Part 1 read here

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