An Article NOT about the Election

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In thinking intensely over what I can write about the election that is health-related and apolitical, I realized that maybe focusing on intentional, unintentional injury could be informative, distracting and, at the very least, make the case for some common ground.

Whether elated, neutral or forlorn this week, you will step away from this piece with knowledge of what not to do.   Or, when to seek help if you do anyway what might not have been in your best interest.

Let’s examine further what it means to be human.  

In my We’re Killing Ourselves piece, I wrote about unintentional injury and its traumatic effects.  If intrigued to uncover how many deaths by cow occur in the U.S. annually, then a quick look might prove educational and underscore its main purpose of promoting prevention.  Additionally, since we experience an uptick in accidental self-injury in the Fall, a little warning before turkey carving this Thanksgiving is discussed in Beware! Don’t Give the Finger this Holiday Season.  

My Inanimate Objects in Orifices series took on foreign bodies in the body - and, yes, I have yet to complete it.  We last left off with the vagina.  This collection investigates intentional, unintentional injury and if you were taken aback by the coaxial cable voluntary urethral insertion, then the recent news out of China regarding the potentially fatal consequence of a man lodging a reported stainless-steel chopstick in his penis will be of minimal surprise.  

Of less invasive, but life-threatening mention is the du jour competitive food challenges that abound in restaurants and on social media these days.  Recently, a video of two female teenagers went viral depicting their immediate reactions upon ingesting the Carolina Reaper (aka the world’s hottest pepper).  Vomiting, pain and even an apparent asthma attack were precipitated.  

The internet is riddled with these stories.  And, now, The Journal of Emergency Medicine even opted to report of a case of esophageal rupture after ghost pepper ingestion.  “The ghost pepper, or ‘bhut jolokia’ is one of the hottest chili peppers in the world, until it was supplanted by the Carolina Reaper.  Ghost peppers have a measured ‘heat’ of >1,000,000 Scoville heat units (SHU), more than twice the strength of a habanero pepper.” (1)

After consuming ghost peppers in a contest, a 47-year-old man presented to the Emergency Room in severe abdominal and chest pain after violent retching and vomiting.  He progressively worsened as his medical work-up revealed a spontaneous 2.5 cm perforation of his distal esophagus with resultant air and food debris in his chest (where air and food should not be) and collapsing of a lung.  He was urgently operated on, required multiple chest tubes and remained intubated (aka had a tube down his throat to breathe) for 14 days.  He went home on day 23 with a tube in his stomach.  

The eating of the peppers was the catalyst that triggered Boerhaave Syndrome, a barotrauma-inducing spontaneous esophageal rupture due to the extreme retching and vomiting.  It "results in tears through all three layers of the esophagus, causing a chemical and bacterial mediastinitis (aka inflammation of the mediastinum or area in the center of the chest).  Even with supportive and surgical care, Boerhaave Syndrome carries a high mortality rate ranging from 20% to 40%.  If left untreated, mortality approaches 100%.”  (2)

So, we are literally making ourselves sick.  

According to the American Chemical Society, the active ingredient in hot peppers contributing to the perception of hotness is capsaicin.  Typically found in the membrane of the seeds, this colorless, odorless compound when eaten “binds to pain receptors present on the surface of the tongue.  These receptors send a signal to the brain that tells the person that the pepper is hot.  This signal is relayed by successive neurons, each releasing brain chemicals that give that ‘hot’ sensation…If you have not worked a tolerance for hot peppers, not only will your pain receptors trick your brain into thinking you are being burned, but your body may mount an inflammatory response, as well.  This response can cause your throat to swell, making it difficult to breathe, and it can damage your intestinal tract.”  (3)

Basically, the cascade of events following consumption of the hot pepper tricks your body into thinking it needs to get rid of this toxin or irritant.  So, it is actually the inflammatory response your body manifests that prompts such struggles.  

What’s the take home lesson here?  We all have a natural curiosity, whether it be in the teen years or cycling through middle age.  Some of us opt for activities like signing up for a new cooking class or soccer league while others seek adventure in random or peculiar places.  Be sensible.  Enjoy life, but certainly attempt to avoid the irreversible high risk endeavors while seeking prompt medical attention if you simply can’t resist. 



(1), (2) Arens A, Ben-Youssef L, Hayashi S, Smolin C.  Esophageal Rupture After Ghost Pepper Ingestion.  The Journal of Emergency Medicine.  pp.1-3, 2016.

(3)  Rohrig B.  Hot Peppers: Muy Caliente!  ChemMatters - A publication of the American Chemical Society (  pp. 6-8.  December 2013/January 2014.