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This past weekend, while having dinner with friends, the husband of the couple we were with and I were talking about blood pressure and cholesterol, (which those of you under 40 will be doing someday too). One of my sons, 9 years old, was standing nearby, and later asked me if the man was a balloon twister. I said, no, why? He said, 'Because I heard you talking about 260's..."
Bennett/Chooch
Surgical Emphysema
...then you are inflating your balloons incorrectly, and you MUST learn to keep your cheeks in when you blow up balloons! Skin and tissue are simply AMAZING materials. They don't respond like a typical inanimate object because they are ALIVE! When you pull on a piece of metal, it stretches. When you pull on a piece of living tissue, it responds in many ways:
So back to balloons - if you stress your cheeks by puffing them up, they are going to stretch. Tissues stretch, then rip, capillaries break, tissue dies and is sloughed off. Then the body tries to relieve the stress by causing more tissue to grow. This leads to Dizzy Gillespie cheeks and jowls. If your cheeks are peeling, give them a rest until they're completely healed (they will still be permanently enlarged - this happens every time you stress your cheeks this way, but it takes a couple of years for the enlargement to become noticeable). Then, practice inflating balloons with your cheeks tight. You have to concentrate on it - even now, after 25 years, I have to remind myself. What I do is I make a definite effort to keep my cheeks held in. I squeeze them shut when I blow. It hurts otherwise. It's never too late to start doing it right. The condition will only get worse, not better, if you continue with bad habits. If you simply can't learn to inflate the balloon without puffing your cheeks, use a pump. There's no reason to hurt yourself - balloons are supposed to be fun for everybody.
It seems easier to puff your cheeks when you first get started, but it's actually harder. You will inflate your balloons faster and more easily when you learn to hold your cheeks in. Try really hard not to puff out your cheeks when you inflate. All the power comes from your diaphragm. If you are using your cheeks or allowing them to puff out, you are dissipating some of the force of the inflation. This is why many people can't inflate the 260. They use cheek power instead of the diaphragm. This is also why horn players do it so well because they are used to using the diaphragm to produce the column of air.
I am now happily twisting away again, with my shoulder not bothering me. I am so glad I learned to blow the balloons up by mouth. I still keep the pump with me, unless I am at a party, where I use Pump O. You never know when I might need it, like when I'm using one of the new metallic colors.
I guess the next step is to find an electric pump that is not so loud it drives the people nuts.
I've also discovered that Vitamin B 6 (100mg) 3 times a day really helps aleviate the pain.
So you do the math. The numbers do fluctuate. But let's give a little perspective.
My traffic school instructor said tonight that 44,000 individuals die in auto
accidents every year. The Balloon council booklet ends the article by stating that
the leading cause of death for children are tricycles and bicycles, numbering 288
fatalities per year. So, please, inform parents about these stats, and let's not
let myth and fear surround our twisting when parents ask us about choking. Of
course the #1 rule should be for twisters and parents to exert caution with
balloons.
To order this brochure, call 800-233-8887.
Beware of the parent who says, "Well, just make me one instead" or "Just make her sister an extra one instead." You know damn well they are going to walk five steps and hand that baby the balloon. It just makes me sick.
I have dealt with it a few ways myself: running after them and returning the tip and retrieving the balloon from the toddler's mouth, saying "Mommie, have you ever seen a child choke to death on a balloon?" No matter what her reply is I will say, "I haven't, and I don't want to see it today. So please keep the balloon out of Bobby's mouth (I AM smiling, but I am also firm.)
Paragraph 2 states, "The No. 1 risk to children at play remains the simple balloon, said Vivien Watts, director of the Illinois Public Interest Research Group". The article continues with information about common toys deemed most dangerous and near the end states, "In 1996 alone, said Watts, 13 children died playing with toys. Ten of them died from choking, and seven of those children choked on balloons".
And, in her conclusion, stated, "Choking on small toy parts, balloons and small balls continues to be the leading cause of toy-related deaths, killing about 15 children each year since 1980, according to commission statistics. "Little kids pick up the balloons, open them and inadvertently inhale a small portion of the balloon", said Dr. Steven Krug, head of emergency medicine at Children's Memorial Hospital in Chicago."
While the death of any child is clearly a horrible tragedy, we all need to consider each of the risks we face relative to the multitude of risks that are out there.
For example, what does the CDC National Center for Health Statistics say about infant mortality?
In 1995,looking at all races, both sexes, ages 1-4 (the ages most likely to be putting objects in their mouth), you'll see that 6,393 children died. Of those deaths:
Hmmm.
Those numbers look a LOT bigger to me than the 15/year rate quoted for choking on balloons. Could it be that infants choking on balloons, while a terrible tragedy, is actually a fairly uncommon cause of infant mortality?
Yes, I think we can say this is objectively true.... So what's the point of all this?
Rather than focusing a lot of attention and concern over a miniscule risk that is basically not even "on the charts", I'd suggest parents and concerned citizens....
Does this mean that balloon professionals should encourage the careless use of balloons in conjunction with children, for example giving balloons to small children to play with unsupervised, or failing to pick up and dispose of the pieces of a broken balloon? No, obviously it does not. However an inspection of the numbers SHOULD help put the relatively small risk associated with choking on balloons in perspective and avoid hysterical overreaction to a risk that is manageable with a few simple rules:
... Latex balloons are particularly hazardous to kids. Latex is smooth and conforms to the trachea -- it blocks a child's airway and is almost impossible to expel with the Heimlich maneuver. Shiny foil balloons are easier to inflate (and therefore less likely to be sucked into a child's throat) ... do not tend to explode into small pieces ... and are less likely to comform to the shape of the trachea if they are accidentally swallowed. Heather Paul, PhD, executive director, National Safe Kids Campaign, Washington, DC.
They assert that mylar balloons would be less likely to block a child's airway and also suggest modifications to latex balloons. These modifications include: establishment of a minimum size, inclusion of a rigid plastic ring in balloons (though what happens when the balloon breaks beats me), texturing the balloons to allow a greater chance of airflow, putting something bitter on the balloons to make them taste bad, or finding a latex-like substance that dissolves on contact with saliva.
The part of their study which breaks things down by age (recall, the newspaper reported that a greater proportion of kids over 3 choked on balloons) actually looked at objects classed by shape or consistency, not specific type. In both cases, balloons fell into the "conforming" category. This category also included other objects, such as disposable diaper stuffing. I'm not sure from the article just what proportion of the "conforming" categories were balloons (the numbers are less than precise in this case). In their discussion, they tend to equate "conforming" with balloons.
CHICAGO--Researchers are urging the US government to regulate balloons and tighten restrictions on other products made for children, after finding that many choking deaths are caused by objects that meet government standards, according to an article in this week's issue of The Journal of the American Medical Association (JAMA).
Frank L. Rimell, MD., formerly of Children's Hospital of Pittsburgh, Pa., now with the University of Minnesota, Minneapolis, and colleagues conducted what is believed to be the first analysis of the shapes, consistencies and sizes of objects causing choking deaths in children.
They examined the medical records of 165 children who underwent endoscopy for foreign body aspiration or ingestion at Children's Hospital of Pittsburgh between 1989-1993. They also examined records from the Consumer Product Safety Commission (CPSC) on 449 children, aged 14 years and younger, who choked to death on nonfood objects between 1972-1992.
The researchers found that conforming objects such as balloons were responsible for the most deaths (29 percent), followed by round objects such as balls and marbles (19 percent), and toy products, parts, or characters (20 percent). The remaining 32 percent of the deaths were caused by products not intended for use by young children.
Of the 165 children treated at Children's Hospital, the items most often recovered were coins and food such as nuts, vegetable or fruit pieces, seeds and popcorn. Other items recovered included plastic pieces, hardware, and batteries.
The researchers found that in both groups, two-thirds of the children were three years of age or younger; however, they found that children over the age of three were twice as likely to die from balloon asphyxiation than children younger than age three. In two cases, children died after choking on latex examining gloves given to them in physicians' offices.
The authors write: "These findings indicate a need for greater public awareness of the dangers balloons pose to children of any age and a search for solutions to the problem. Clinicians should keep examination gloves and similar supplies out of reach of children and caution others caring for, or interacting with, children about the hazards of these objects."
After conforming objects, round objects posed the greatest risk of choking death by a nonfood item. A computer analysis of 101 rigid, three-dimensional objects which had asphyxiated children found that 14 had passed the government's Small Parts Test Fixture (SPFT), which is a cylinder with a diameter of 3.17 centimeters (cm) and a depth between 2.54 and 5.71 cm. Objects that are too large to fit in the cylinder pass the SPFT and are deemed acceptable for young children.
The researchers write: "All 14 of these deaths might have been prevented if the SPFT had been 4.44 cm in diameter and 7.62 cm in length."
They add: "Others have commented that most foods causing choking death are spherical; in several reports the majority of children asphyxiated by food lodged in the airway had aspirated round or cylindrical foods (hot dogs, peanuts, seeds, grapes, and hard candies)."
Designing the Death out of Balloons
In an accompanying editorial in this week's JAMA, Susan P. Baker, M.P.H., and Kopl Halperin, Ph.D., Johns Hopkins School of Hygiene and Public Health, Baltimore, Md., write: "In the new study, a finding of particular interest is the preponderance of balloons among objects causing fatal aspiration. Balloons, long exempted from regulation by the CPSC, kill more children than any other toy except for bicycles and other riding toys."
(What she doesn't say is how many deaths from balloons relative to the other toys. Given the trivial numbers from this study I'm sure its quite a large gap. Reason would suggest we should place our "protective emphasis" on these other toys that are agreater [in relative terms] danger)
They offer several solutions to make balloons safer, including making them with mylar or inflatable paper, neither of which "would be likely to block a child's airway." They also suggest a minimum size for balloons and that a plastic ring of at least 4.4 cm in diameter be placed inside each balloon.
They add: "A minority of balloon deaths involve a broken piece of balloon, but some strategies are applicable to both broken and intact balloons. For example, balloons could be designed with ridges or bumps that would allow air to flow between the surface of the airway and the aspirated latex. To prevent children from mouthing balloons or their fragments, a bittering agent could be incorporated into the balloons, exclusive to the mouthpiece. Other research might yield substances that react with saliva to separate into non-hazardous particles or to form a soluble or non-adherent material."
The editorialists conclude: "The long-standing problem of asphyxiation by balloons should have been addressed long ago. Surely changes can be made now to avert future deaths."
(I hate to say it, since I went to the Johns Hopkins Medical School, but this lady needs to come out of her ivory tower and join reality for a little while. In technical terms, she's a Wacko)
This is the long way, but it seems the best way to respond to your comments on the JAMA article and question "do children die from ingesting balloons?" is to give you the following excerpts from our letter to Dr. Rimmel, author of the JAMA article. It describes the difficulty we have had in getting data that we feel is reliable and the steps we took to develop the numbers we now use. "
Because the information is often not gathered in a scientific manner, we found it necessary to make some judgment calls as to which reports to include and which to label duplicates:
First, we eliminated as duplicates those which involved the same age child, in the same city, on the same date (29 eliminated).
Second, in more arbitrary decisions, we eliminated 14 where the city was not identical, but close enough to reflect home town/hospital site, or the ages of the children differed little (e.g. 1 month vs. 7 months). Along the way, we found two deaths that were reported three/four times.
At the conclusion of these calculations, we have a total of 129 deaths from choking on a latex balloon from 1980-95. These are the numbers we will use until we get further updates...You will note that whereas when we relied on the 1994 figures supplied by the Clearinghouse we had 110 deaths from 1981-90, the new total now is 82. Repeating the calculations in Mr. Flynn's letter to JAMA, we still find the trend is in the right direction--although not as dramatic as with the old numbers. The average number of deaths the 10 years before warning labels (1981-90) was 8.2. In the four years after, the average was 6.7.
Considering how many more latex balloons are being sold and the new law requiring that all incidents involving latex balloons be reported, it is clear that the education program is making progress.
Patricia Bario Public Information Officer The Balloon Council 71310.3323@compuserve.com
A group of doctors from Belfast report in the British Medical Journal that blowing up balloons for Yuletide parties can damage your lungs, causing air bubbles to spread under the skin. They cited the case of a 24-year-old man hospitalized with lung problems after blowing up 20 party balloons in an hour.Although he felt no ill effects at the time, he became sick 48 hours later. The doctors said air bubbles could be felt under the skin on his back and buttocks and there was a "crunching sound" when he breathed.
Stuart Elborn and his medical colleagues found that the air pressure involved in inflating balloons is enough to damage the alveoli, tiny sacs in the lung through which air is absorbed.
The researchers said they cleared up the problem in 10 days using antibiotics, painkillers and fluids.
I have been doing balloon deco for about 3 years full time. The doctors are all fairly certain that the tying of balloons is what got me in this condition... that and me not being smart enough to do something sooner.
Please see a doc ASAP. Right now I am typing this with one hand as the other arm is in a full cast from my shoulder to my fingers. It appears that I am going to be out of commission for about 8 weeks with this, during one of the busiest seasons here in Phoenix. Fortunately, I have a partner (my sister) who is fully capable of handling things.
I hope that you will find that what you have going on is easy to fix and that my information got you in to see someone at the beginning stages of whatever your problem is.
Hope this helps those in need, but again, I urge you to seek out a doctor. It took two years to figure out that what I had was CTS.
Dry hands and rough fingernails
ELASTIC
P.O. Box 2228
West Chester, PA 19380
You will get info on Latex Allergy News (you can subscribe), a flyer from the American college of Allergy, Asthma and Immunology with Q & A on latex allergy, and information on ELASTIC (Education for Latex Allergy Support Team & Information Coalition Inc.)
The ALERT support group site is good also. You can order a School Education Packet from them. Look under Products.
Other info can be found through the Latex Allergy Information Service (203)482-6869; E.L.A.S.T.I.C. (610)436-4801; A.L.E.R.T. (414)677-9707; G.L.A.S.S. (313)351-9788; and FDA Latex Allergy Hotline (301)594-3060.
As of June 1st,1997 No LATEX BALLOONS at 3 Main Area Hospitals
"We want to provide the safest possible environment for patients and staff. Latex balloons are the leading cause of pediatric choking deaths in the U.S. An increasing number of patients and staff have developed an allergy to latex. Symptoms of latex allergy may be mild or severe and range from hives and swelling to respiratory failure. Mylar/Foil balloons will only be accepted."
Only few blurbs about balloons...they had one lady who said she got a rash around her mouth after blowing up a balloon. Then they showed a package of balloons when they were showing common products made with latex.
Over all, it didn't seem to point out that balloons were a major contributor to latex allergy cases but that latex gloves were.
Debilitating, Sometimes Deadly Latex Reactions Pose Medical Peril
By SUSAN DUERKSEN, Staff Writer
Augustine Carrillo is not expected ever to talk, possibly not to walk, certainly never to work. The 1-year-old is profoundly brain-damaged, his parents say, because of a rubber-tipped catheter.His story is among the most horrific consequences to date of a mysterious epidemic of severe allergy to latex rubber. The unusually menacing allergy has sprung up within the past decade and has quickly become a major concern for health-care workers.
Ironically, the often life-threatening sensitivity to latex apparently arose from a sudden surge in the use of latex gloves to protect doctors, nurses, dentists and others from another hazard, the AIDS virus.
Besides more people having more contact with latex, many researchers--and lawyers representing the victims--believe gloves became more allergenic because manufacturers cut corners to produce more gloves faster.
Augustine's mother, Mildred Carrillo, was an intensive care nurse at San Diego's Mercy Hospital before his birth there in January I995. She had suffered rashes and wheezing on the job for five years, she said, and had finally concluded she was allergic to latex.
During her labor, all the nurses and doctors knew of her allergy and knew they should not use latex equipment. But one nurse accidentally used a latex catheter to drain her bladder, telling Carrillo it was not latex.
Carrillo immediately went into anaphylactic shock--marked by difficulty breathing and feeble blood pressure. For about 20 minutes, she struggled to breathe while the nurses tried to give her oxygen, said her husband Richard.
"I couldn't get air," Mildred Carrillo said. "I was suffocating."
Market Demands Spread the Problem, Some Say
After she was stabilized with shots of three drugs, her son was born by emergency Cesarean section. According to a lawsuit the Carrillos have filed against Mercy, his brain was severely damaged by oxygen deprivation and the drugs necessary to save his mother.
The Carrillos are suing for the lifelong costs of care for the vacant-eyed boy they call Auggie, for an amount not yet determined.
Patting her son's chest as he arched into one of his frequent seizures, the 32-year-old San Diego woman said doctors are unsure the boy ever will develop basic skills. He now is fed through a tube into his stomach because he cannot swallow adequately.
Mildred Carrillo's severe reaction to the inadvertent use of a latex catheter during the birth is not disputed, but Mercy has not agreed that her shock caused the brain damage, said Cary Miller, attorney for the hospital.
Nonetheless, Mercy embarked a year ago, just after Auggie's birth, on an aggressive effort to identify and protect latex-allergic employees and patients and to buy latex-free products where possible. Some other local hospitals are following Mercy's lead, but at many it is not a high priority.
The Word Spreads
"The word is just getting out about latex allergy now," said Mary-Michael Brown, a nurse specialist who headed Mercy's latex task force. "The medical community is really just beginning to believe it and act on it."
The U.S. Food and Drug Administration issued a medical alert five years ago, in March I991, warning all health-care professionals to identify latex-sensitive patients and be prepared for severe allergic reactions.
The alert followed reports of 15 deaths among patients who went into shock while having barium enemas with rubber-tipped catheters.
I suspect there are multiple other deaths out there that we don't know about," because they are listed as having other causes, said Dr. B. Lauren Charous, a Wisconsin allergist and chairman of the American College of Allergy Asthma and Immunology's Latex Hypersensitivity Committee.
"We have health care workers who can't work." Charous said. "We have people who are disabled, I'm very worried because I'm seeing more patients."
The few studies that have been done estimate that latex allergy affects from 5 to 20 percent of all health-care personnel who wear gloves much of the workday, including nurses, laboratory technicians, dentists and others.
An even more profoundly affected group--up to 65 percent latex allergic--are children with spina bifida. Those children commonly have multiple surgeries and catheterizations at very young ages, involving direct contact of batex with the bloodstream.
The federal Centers for Disease Control and Prevention (CDC) recommends that everyone undergoing surgery or dental procedures, as well as anyone being hired for a health-care job, should be asked if they are allergic to latex.
A Protein Problem
Latex is a natural product from rubber trees and contains many proteins that can provoke allergic reaction. It bas been prevalent in home as well as medical products for decades. Rubber bands, shoes, elastic, pacifiers, toys, balloons, bandages, band grips on rackets and bicycles, erasers, tires, condoms, diaphragms and many other items contain latex.
But some latex products are more hazardous than others, and an allergy generally develops after extensive contact. Latex gloves usually are dusted with cornstarch, which can bind to the proteins, pull them off the latex and rub them into skin. Or the powder can carry latex proteins into the air, where they can be inhaled.
Some of the same proteins are found in certain foods--primarily bananas, avocados, kiwis and chestnuts--which often cause reactions in people with latex allergy.
The amounts of the problem proteins vary drastically between brands of gloves, said Dr. John Yunginger, an allergist at the Mayo Clinic in Minnesota. Until recently there were no good ways to measure the protein levels, he said.
The demand for latex gloves-- which are stronger and allow more touch sensitivity than vinyl or the alternatives -- skyrocketed in 1987, after the CDC recommended that all health-care workers protect themselves from all patients' blood fluids to prevent transmission of the human immunodeficiency virus. To meet the demand, new manufacturers jumped into the market "who didn't know what they were doing," Said Wava Truscott, vice president of Safeskin Corp., a San Diego- based glove maker. At the same time, she said, efforts to clean up industrial discharges and boost the production at Southeast Asian rubber tree plantations inadvertently increased the amount of proteins on glove surfaces.
But Charous said many manufacturers sped up production without regard to the consequences. "One explanation would be that because of economic demands a different kind of rubber was produced that had more allergens," he said. "I think they did get sloppy."
Allergy Prevention
Prodded again by market demands, some glove-makers now are adding production steps to leach allergenic proteins from latex, Truscott said.
The FDA has encouraged manufacturers to make and market low-allergen gloves, but has not yet required any changes. A proposed regulation requiring simply that any product containing latex be so labeled has been in the works for three or four years.
Mel Stratmeyer, chief of the health sciences branch in the FDA office of science and technology said the regulation has been delayed by the office's workload and he cannot estimate when it might be implemented.
"I would say it has a high priority at this time," Stratmeyer said. "I really have no control over when it gets through."
In the Carrillos' case, the catheter package was clearly labeled as containing latex, said R. Christian Hulburt, the family's attorney.
Requiring labeling should have been done long ago and won't be enough, Charous said. His national committee has recommended that the FDA set maximum levels of the allergenic proteins in latex products, but Stratmeyer said it is faster to encourage voluntary cooperation by manufacturers.
Besides gloves and catheters, many other medical supplies contain latex, including intravenous tubing, rubber stoppers or syringes and tourniquets. Non-Latex alternatives are become more available, sometimes at lower cost, and some nurses say new powder-free latex gloves don't cause reactions.
For many heath-care workers, Latex allergy begins with rashes and itching on the hands and progresses to hives, then asthma, watering eyes and sneezing.
Finally, some people become so sensitized that even breathing the air where someone else has taken off latex gloves can cause the swollen airway and lowered blood pressure of anaphylactic shock, a reaction rarely seen in other allergies.
'Couldn't Breathe. . . Think'
Kirsten Clark, of Point Loma, knows the panic of that feeling too well. After 10 years as a nurse, she risks her life entering a doctor's office or hospital. When she takes her 4-year-old daughter to the doctor, she waits in the parking lot.
"I couldn't breathe, I couldn't think, I couldn't see," Clark, 37, said of her first episode of anaphylactic shock a year ago, "You only have to do that once to be terrified. There's never been an allergy like this."
Clark left her job at Scripps Memorial Hospital in La Jolla last year. She said she never heard of the FDA's 1991 alert until this year.
Lt. Harold Henderson, a Navy emergency nurse for eight years, also can no longer work in his profession. After several episodes of shock, Henderson said he carries a syringe of epinephrine, an adrenaline shot that counteracts the symptoms, wherever he goes.
I have to watch, for the rest of my life, every single thing I come in contact with," said Henderson, 38, of Rancho Penasquitos. He said he knows of other military nurses who are "suffering in silence," taking allergy medication and continuing to work rather than give up their careers.
At the San Diego Naval Medical Center, where Henderson worked, vinyl gloves are available for those who want them and a task force is looking into what else should be done, said Capt. Fang Lin, head of the hospital's allergy clinic.
In the Scripps Health system, a task force was formed last month and is aiming to make the system's six hospitals "latex-safe" within the next few months, said assistant administrator Paula Smith. "We will be substituting latex- free products wherever we can," she said.
In the six hospitals of the Sharp Health Care system, non- latex gloves are available but the issue is otherwise "a low priority right now," saidspokeswoman Stephanie Casenza. Dr. Ronald Simon, at Scripps Clinic in La Jolla, said he is about to begin experimenting with a treatment to desensitize people to latex. He plans to inject "incredibly small doses" of latex proteins into people who are highly allergic, just as bee venom injections lessen bee sting allergies.
The researchers took six brands of gloves, soaked them in salt water to extract the proteins and then mixed them.
Simon said he is prepared for the risk of severe reactions to the shots, but already had the 12 volunteers he needs initially.
CONCLUSIONS: The results suggest that the SB population is unique in demonstrating IgE responses to latex contact, which may be due to increased latex exposure or altered neuroimmunologic interactions.