University of South Florida Medical Center

VOLUME 6 November 1994 Number 2

Director's 3 0 r u ~ H. Worth Boyce, Jx, M. D. - Director and Hugh E Culverhouse - Chair of Esophagology

In Memorium: Hugh F. Culverhouse On August 25, 1994 the person most responsible for the establishment and development of the Center for Swallow- ing Disorders passed away. Hugh Culverhouse was a friend and gentleman in every sense of the words. He was a re- spectful and compliant patient who demonstrated warmth and affection toward all of us. As a strong proponent for education and respect for the medical profession, he readily supported many types of academic needs through his lead- ership and benevolence, both in Florida, especially at the University of South Florida, as well as at his Alma Mater, the University of Alabama.

Hugh Culverhouse was not asked to provide support for our Center - he asked how he could help when he learned of the concept for developing the Swallowing Center. He had a personal interest in the difficulties suffered by patients with swallowing disorders since he had been bothered by such a problem for many years. His initiative included the

services and uses no donated funds for operational expenses. Our patients, their families and others provide donations that are used to support research and educational programs. Before his death Mr. Culverhouse was aware of the success and fiscal independence of our Center and appropriately took great pride in his pivotal role in this success.

The Swallowing Center was opened for its clinical opera- tions in May, 1987 and in October, 1988 Mr. Culverhouse and his family made another major contribution to medi- cine and medical education at the University of South Florida College of Medicine by establishing the Hugh F. Culverhouse Chair for Esophageal Disorders. This Chair is related to the Swallowing Center in that the incumbent for this chair also will serve as the Director of the Center. This relationship will assure leadership in future years as well as an expanded commitment to patient care, teaching and research in swal- lowing disorders.

of support from area corporations plus his own financial commitment for the purpose of providing funds to The Director and Staff of the Swallowing Center are ex-

establish the Center, hire the needed medical support per- tremely grateful for the interest, encouragement and finan-

sonnel and purchase the equipment needed to operate for cia1 support provided by Hugh Culverhouse and his family

its first five years of existence. He did just that and we were and wish to formally express our gratitude and our sincere

able to develop a broad patient referral base that has in- sympathy over the loss of this warm friend, patient and

cluded patients from 27 states and 4 foreign countries to generous benefactor. All who knew him well are unanimous

date. Our patient services are primarily oriented toward in recognizing him as one who was the epitome of a loyal

management of complex swallowing disorders and offering friend, brilliant as a lawyer and in business, exemplary as a

diaanostic tests and treatment techniaues usuallv not avail- leader and humanitarian, and a true gentleman.

able in most areas. At present the center for swallowing Disorders operates from funds acquired through its patient

H.Worth Boyce, Jr., M.D.

Bizarre Swallowing* (Part 11)

Turning to bizarre swallowing, it is quite extraordinary the amazing variety of objects people swallow. There are a num- ber of reasons for this; financial gain, an obsession or an act in the music hall, circus, fairground and, more recently, television.

. These have ranged from enormous amounts of food and drink, to all sorts of metal objects - keys, rings, pieces of chain, razor blades; progressing to electric light bulbs, chew- ing up drinking glasses and finally live creatures such as gold- fish, mice, frogs and - the mind boggles - even white rats.

Apart from food and drink, there is in the trade a very defi- nite distinction between the amateur and the professional, the former merely swallowing inanimate things and hoping that his digestion will cope, and the latter, who has learnt the act of re-gurgitation, bringing up the object under strict control.

However, the two most celebrated arts of swallowing are fire eating and sword swallowing.

In the last issue we presented Fire Eating and below the fine art of Sword Swallowing is discussed.

Sword Swallowing

Turning to sword swallowing, this art is very old. Traveling jugglers did it for the Pharaohs, Agrippa mentions seeing it in ancient Rome, but he was somewhat drunk at the time and later ascribed what he saw to the wine. Remy, the great 15th century philosopher decided sword swallowing was done with the aid of demons. For a long time many people thought it was a fake with the blade folding up into the handle. Robert Houdin, the famous French magician was sent by his government to Algeria, towards the end of the last century, to expose the Arab conjurers. He could ex- plain all their tricks except sword swallowing.

Many different types and sizes of implements are used, in- cluding swords, cavalry sabers, rapiers, bayonets, scissors and even a giant corkscrew. The latter in particular pro- duces a horrible effect, making the Adam's apple leap about.

Swords vary in length from 8 inches up to 2 feet and are usually bought from pawn shops where they are cheap. They require to be nickel plated to make them smooth, it is im- portant to always wipe the sword before swallowing it, be- cause even the smallest particles of dust on the blade will produce retching. It is also essential to ensure that the blade is firmly fitted into the hilt, otherwise it falls out and the performer really does swallow it.

The technique of course, is exactly that of passing a rigid oesophagoscope, the problem being to overcome the gag reflex and sudden closure of the cricopharyngeal sphincter which is the main obstacle. Most artists start training by swallowing a crude ball of wadding around a lead pill at- tached to a length of cotton.This is swallowed and pulled up repeatedly until the time has come to try a sword but even then it is some while before the throat becomes accustomed to the touch of cold steel. The length of sword that the man

can swallow is determined of course by the distance from his lips to the pit of his stomach. Dan Mannix, a famous American performer, being tall was able to swallow a very long saber with a blade of 26 inches.

There is considerable rivalry between swallowers and a few years ago the Sword Swallowing Championship of the World was organized between Manniz and a Hindu, Mohammed Ali. The latter had a considerable reputation calling himself "The King of Swords", with an impressive repertoire that included swallowing a sword with a tin blade and then twist- ing himself around until the sword was bent inside him. Amazingly, he could straighten it out by contracting his stom- ach muscles and then withdrawing it.

Mohammed was obviously a man of considerable ingenuity as he also swallowed red hot swords glowing in the dark with puffs of stream coming out his mouth, having surrepti- tiously swallowed an asbestos scabbard beforehand off-stage. His finale was swallowing an apparently very thick sword which was really a sword in a scabbard, the latter being covered with aluminum paint to resemble a sword blade. He then pulled out the sword leaving the scabbard inside him. This contained paper flowers and, the American flag which he withdrew out of his mouth with great gusto to the tune of "The Star Spangled Banner".

The final test between the G o was who could swallow the longest sword. Mannix reckoned he could not lose as he was a tall man and proceeded to swallow a 26 inch sword making sure the hilt rang against his teeth. However, the crafty Indian, much the shorter of the two ate a heavy meal weighing down his stomach before the contest and won by swallowing a sword 3 inches longer.

A fascinating alternative to swords is the swallowing of neon tubes in the dark, when stripped to the waist and they are turned on, the light shinning through the chest is pretty effective. Even skeptics are impressed. They are specially made, being thin, brittle "U" shaped tubes with the ends sticking out of the mouth to which are attached the electric leads. This presents certain problems as they easily shatter and if too warm stick to the performer's insides, which would make for a difficult oesophagoscopy.

Accomplished regurgitators have already been mentioned. Training is much the same as for sword swallowing but it can take 6 months or more of steady practice before con- trol is achieved. The act is probably a crude form of yoga and many people practice it as a health measure. Certain animals have the power and trappers have~found it difficult to poison wolves as the animals can discharge the bait as soon as they feel the first warning pangs.

There was a delightful Austrian character who toured the Continent and used to say he was trained in the "Viennese Ostrich School". Although it was his living, he stoutly main- tained it was also his hobby as other people go in for golf and bridge. To complete his act the Ostrich would swallow 20 glasses of water and then regurgitate it slowly to the tune of 'The Indian Love Call" played on a guitar. What a marvelous picture this conjures up!

* From Lund, WS.: J n l Royal Soc Med 1990;83:138-142.

Effect of Decaffeination of Coffee or Tea on Gastroesophageal Reflux

Coffee and tea are believed to cause gastroesophageal re- flux; however, the effects of these beverages and their ma- jor component, caffeine, have not been quantified. The aim of a recent study was to evaluate gastroesophageal reflux induced by coffee and tea before and after a decaffeination process, and to compare it with water and water containing caffeine.

Three hour ambulatory pH monitoring was performed on 16:healthy volunteers who received 300 ml of regular cof- fee, decaffeinated coffee or tap water. Six volunteers re- ceived normal tea, decaffeinated tea, tap water, or coffee adapted to normal tea in caffeine concentration. There were 8 who received caffeine-free and caffeine-containing water together with a standardized breakfast.

Results: regular coffee induced a significant gastroesoph- ageal reflux compared with tap water and normal tea, which were not different from each other. Decaffeination of cof- fee significantly reduced gastroesophageal reflux, whereas decaffeination of tea or the addition of tea to water had no effect. Coffee adapted to normal tea in caffeine concentra- tion significantly increased gastroesophageal reflux.

Conclusion: coffee, in contrast to tea, increased gastroe- sophageal reflux, an effect that is less pronounced after decaffeination. Caffeine does not seem to be responsible for gastroesophageal reflux which must be attributed to other components of coffee.

Avoid Holiday Heartburn

During the holidays rich foods, large meals, and alcohol can lead to attacks of heartburn.

Heartburn is a term that is sometimes misleading. It has nothing to do with your heart. Heartburn results from a backup of acid-containing stomach contents into your esophagus (feeding tube).

Ten percent of healthy people have at least one episode of heartburn each week. Here's what you can do to prevent heartburn:

Eat smaller meals - Too much food expands your stom- ach and puts pressure on a band of muscle (esophageal sphincter) that helps keep food in your stomach.

Avoid alcohol, fatty foods, chocolate, spearmint and peppermint - These foods can relax your esoph- ageal sphincter and promote upward flow of stomach con- tents.

Use an antacid - People most often take over-the-counter antacids to relieve symptoms of heartburn. But an antacid also can help prevent symptoms. Take it after meals and before bedtime.

Don't eat before sleeping - Wait two to three hours after eating before lying down. This allows enough time for increased stomach acid produced by your meal to taper off.

Wear loose clothes - A tight belt, girdle, or waistband can cause heartburn.

Stop smoking - The nicotine from cigarettes can relax your esophageal sphincter.

Elevate the head of your bed - Raise the head of your bed 4 to 6 inches. This helps keep stomach acid in your stomach where it belongs.

When the holidays are over, if you are overweight, make a commitment to lose weight. Trimming down helps reduce the pressure your abdomen puts on your stomach when you are lying down.

8th World Congress of Endoscopy

Dr. Boyce served as President of the 8th World Congress of Endoscopy that was held in Los Angeles October 2-9,1994. This Congress was held in conjunction with the 10th World Congress of Gastroenterology. Four years of planning led to a most successful scientific meeting with over 8,000 gas- troenterologists and gastrointestinal surgeons in attendance.

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Helpful Hints

A Blow Dryer Can Speed Skin Healing

A hair d y e r can help speed up the healing of skin that's raw or abraded due to friction, rug, mat or asphalt burns; thermal burns; sunburn; chafing; rashes; jock itch; skin irritation in the vaginal area; poison oak or poison ivy. Thoroughly cleanse the wound with soap and water at least twice a day, gently pat off excess water and then turn on a blow dyer (at low-heat setting) for 1 0 to 15 minutes to d y the area. "Leaving a wound d y and exposed to sir speeds healing and decreases the risk of secondary infection," says Michael Papciak, M.D., a sports medicine specialist in Atlanta. It also reduces itching. However, before sleeping or any kind of vigorous activity, he recommends covering the affected area with bandages to protect it.

Dying with a blow dyer for 1 0 to 15 minutes is roughly the equivalent of a day's worth of air exposure, he estimates, so you can shorten healing time considerably.

During the past six months, members of the Center for Swallowing Disorders staff have continued their active participation in graduate medical education at regional, national, and international meetings. These presentations on topics related to swallowing disorders require considerable research and time to prepare teaching slides and videotapes. Contributions to the medical literature in journals and textbooks also have been significant.

Lecture Presentations by CSD Staff

1. July 11, 1994: Esophageal Dysphagia. Graduate Level Speech Pathology Course, USF College of Medicine, Tampa, FL. (Jones)

2. July 13, 1994: Esophageal Dsyphagia and Case Presentations. Graduate Level Speech Pathology Course, USF College of Medicine. Tampa, FL. (Boyce)

3. August 25, 1994: Management of Barrett Esophagus. Gastroenterology Grand Rounds, Duke University Medical Center. Durham, NC. (Boyce)

4. September 30, 1994: Advanced Endoscopic Skills Seminar. San Francisco, CA. (Boyce)

5. October 2, 1994: 1) Dilation of Benign and Malignant Strictures; 2) Endoscopic Ultrasonography. Gastrointestinal Endoscopy Postgraduate Course, World Congress of Endoscopy. Los Angeles, CA. (Boyce)

' 6. October 10-12, 1994: Upper Gastrointestinal Endoscopy - Moderator. Future of Endoscopy Postgraduate Course. Vancover, B.C. (Boyce)

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