Lesson 4. Understanding Animal Health Medications and EquipmentCalifornia Academic Standard. Science—Grades 9 through 12—Investiga- tion and Experimentation—Standard 1m: Scientific progress is made by asking meaningful questions and conducting careful investigations. As a basis for understanding this concept and addressing thecontent in the other four strands, students should develop
Microsoft word - nothing to sneeze at.docNothing to Sneeze at: Skydiving with a Cold or Allergies
by Musika Farnsworth
Ear or sinus problems at altitude are more than an inconvenience. They can get so
intensely painful that they disorient or disable a skydiver in the plane, in freefall or under
canopy. Damaged sinuses may take weeks to recover, and ear damage may result in
permanent hearing loss or vertigo.
“I felt fine when I got in the plane, but around 7,000 feet, I got this severe pain in my
sinuses. It was excruciating—worse than the worst migraine. I was actually scared,”
recalls Jeff Tarinelli of Portland, Oregon. Tarinelli says he immediately took sinus
medication once on the ground and felt fine again within ten minutes. “Now, I always
carry decongestants in my gear bag just in case,” he says.
Kimberly Kaplan, also of Portland, had a similar experience. “On the ride to altitude, I
had this tingling and crinkling sensation in my sinuses,” she says. “But otherwise, it
didn’t hurt, and I felt fine. During freefall, though, at around 8,000 feet, it felt like a hot
poker going right through the left side of my forehead. It was so intense I seriously
wondered if I had turned on my Cypres just in case. I had to deploy at 6,000 feet.”
Ear Pain While Skydiving
The ear pain a jumper might feel while skydiving originates in the middle ear, which is
essentially a pocket of air. It’s normal and necessary for this pocket to be full of air. To
provide clean, fresh air to the cavity, the tissue lining the area regularly absorbs the air
inside it. Fresh air refills the middle-ear pocket by normal breathing through the mouth or
nose, and the nose connects to the middle ear by a tiny, thin tube called the Eustachian
tube. Fresh air enters the Eustachian tube and ear when swallowing, and the familiar
clicking or popping sound on every second or third swallow is the bubble of air going
into the middle ear.
In physics, Boyle’s Law states that when pressure increases or decreases, a volume of gas
responds in the opposite direction. Therefore, as pressure decreases during the climb to
altitude, air in the middle ear expands inside the cavity. Ear pain during ascent generally
comes from air pushing out and against the eardrum. The membranes in the ear usually
absorb excess air fairly easily, even if a jumper has a slightly stuffy nose or a swollen
Eustachian tube. The pressure change makes it possible for ear or sinus pain to subside
somewhat in the plane—but the pain will return on descent.
During descent, as air pressure increases, the air pressure in the middle ear decreases. If
the Eustachian tube is not fully functioning, it can become nearly impossible for the
jumper to re-fill that cavity of air quickly enough. An inadequate amount of air in the
middle ear creates a partial vacuum, painfully pulling and stretching the eardrum inward.
This abnormal stretching prevents the eardrum from vibrating properly, making sounds
quiet and muffled. If low pressure exists in the middle ear for a prolonged period of time,
the body will attempt to remedy it the best way it can—by filling the air pocket with
A professor at the Department of Otolaryngology-Head and Neck Surgery at the
University of Texas Health Science Center, Dr. G. Richard Holt is a former Army flight
surgeon, paratrooper and special operations medical officer with years of parachuting
experience. He says, “The sudden negative pressure on the eardrum and inner-ear
membranes can lead to vertigo, nausea and vomiting—not good when skydiving.”
Damage to the middle ear may take several forms. “It is more common for the negative
pressure in the middle ear to cause bleeding in the middle-ear space, leading to terrific
pain and pressure,” says Holt. This condition is usually treated with decongestants and
nasal sprays and generally clears up in three to four days.
Though not as common, Holt says, “It is possible to rupture both the tympanic membrane
(eardrum) and the round window membrane in the middle ear that leads to the inner-ear
balance and hearing mechanisms. The worst-case scenario would be that the rupture
would lead to a hearing loss and persistent vertigo, both requiring surgery to stop the leak
of inner-ear fluids. The surgery is not always successful, and the disabilities could be
Sinuses are also normally filled with air. Like the middle ear, sinuses connect to the nose,
but through a more direct route. Because the sinus is directly connected to the nose, any
type of swelling in the nose can make the sinus unable to adequately receive or expel air,
and the same scenario as seen in middle-ear pain can occur.
Lack of air inside the sinus, known as “sinus squeeze” to scuba divers, may make the
sinus feel like it will burst, because blood vessels inside the sinuses become engorged
with blood and expand. It is even possible for blood vessels to leak, filling the sinuses
with blood. This condition puts a person at high risk for developing sinusitis, a bacterial
infection causing inflammation and blockage of the sinuses. Side effects or symptoms of
sinusitis are headache, pain radiating to the eyes and over the nose, fever, nausea and
chills. Treatment usually consists of antibiotic therapy and warm packs on the sinuses.
The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
suggests avoiding air travel for those who have a cold, sinus infection or even an allergy
attack. However, skydivers are a different breed of air travelers and will try to get in the
air as soon and as often as possible.
To determine whether a skydiver can safely jump, Dr. Holt advises, “After a cold, you
should be free of thick mucus, headache, stopped-up ears, nasal obstruction and should be
able to clear the ears before jumping.”
You can clear your ears, or re-fill the middle ear with air, with the Valsalva maneuver:
Pinch the nose and, with a mouthful of air, try to gently blow the fingers off the nose
using cheek and throat muscles. Holt says, “If you can’t clear your ears with the Valsalva
maneuver prior to getting on the airplane, you should reconsider jumping.”
According to Holt, ear and sinus problems generally arise at about 5,000 to 6,000 feet. It
may be tempting to try just a low hop-and-pop with cold or allergy symptoms, but he
warns that susceptible jumpers may experience pain and problems even as low as 100
For a jumper experiencing ear or sinus pain in the airplane, Dr. Holt advises, “Every
skydiving plane should have a little medical kit that includes Afrin nasal spray. If you
have pain on either ascent or descent, use the Afrin quickly. But don’t try to jump if you
have pain. Just ride the plane down, ask the pilot to have a slow, controlled descent and
try to Valsalva, chew gum, etc.”
Each over-the-counter cold or allergy medication is designed for specific symptoms, has
side effects and treats only symptoms, not the cause. The AAO-HNS website,
www.entnet.org, describes the various medications and some of their side effects:
Decongestants. Decongestants reduce nasal swelling, Eustachian tube swelling, pressure
and congestion by reducing blood flow to nasal membranes. They do not stop a runny
nose, but they improve air flow through the nose. They are most effective one hour
Decongestants are chemically related to adrenalin, a natural decongestant. Typical side
effects of a decongestant are lightheadedness, increase in blood pressure, increase in heart
rate and difficulty with urination. Those with heart disease, high blood pressure, irregular
heart rhythms or thyroid disorders or those prone to anxiety should probably not use
Antihistamines. When a virus becomes established in the nose, the body releases a
chemical called histamine to protect itself and attack the virus. Histamine increases blood
flow to the nose, and this excess blood flow causes the nasal tissues to swell and become
congested. Unfortunately, the body can defend itself this way even without a real virus.
Some people’s systems mistake pollen, grass, dust and other everyday air particles for
viruses. An antihistamine prevents the body from producing histamine, the chemical that
triggers the response to a virus in the nasal system.
Antihistamines do not relieve Eustachian tube obstruction but are designed to relieve
itchy eyes, sneezing, runny nose and nasal congestion. Antihistamines work best if taken
before allergy symptoms appear. Typical side effects include drowsiness and dry nose
and mouth. But according to Holt, “Other side effects that are not as well known are
dryness of saliva and nasal mucus, urination problems and blurry vision.”
But Holt adds, “Now one can use the non-sedating antihistamines (Claratin OTC, Allegra
Rx), and the only side effect might be a dry nose, which can be reversed with frequent
nasal saline sprays.”
Today, most brands offer a combination of decongestant, antihistamine and pain reliever
in one. Compared to a few years ago, newer brands of antihistamines cause less
drowsiness. The first few doses may still cause sleepiness, but these side effects gradually
decrease with subsequent doses. Both prescription and non-prescription medications may
lose their effectiveness after a few years or even a few months, but changing brands or
types of medications may help.
Immunotherapy. Allergy shots, or immunotherapy, are the most specific and successful
treatment for allergy sufferers. Allergy shots build up antibodies in the blood to specific
allergens and cause fewer side effects than drugs. But some side effects still occur.
“There are some early side effects to allergy shots—reactions from mild skin irritation or
rashes to anaphylaxis (sudden systemic allergic reaction involving cardiovascular,
gastrointestinal or respiratory tracts). So jumpers should not parachute until they have
been on the hypo-sensitization shots for several months to make certain there are no
reactions,” says Dr. Holt.
Medicated nasal sprays. Medicated nasal sprays are the fastest and most effective way
to clear swollen nasal membranes and sinuses and to reduce swelling in the Eustachian
tube. They clear the nasal passage almost immediately and are stronger than pill-form
decongestants because they impair blood circulation in the nose.
But blood can be prevented from circulating in the nose for only so long before the
vessels expand to bring back the blood flow. Within a few hours, the membranes will
swell again, and continued use of medicated nasal sprays can eventually cause blood
vessels to lose their capacity to constrict. The AAO-HNS advises use of medicated nose
sprays only when absolutely necessary and for no more than three to five days.
To Jump or Not to Jump
It may be tempting to try to jump with the help of over-the-counter medications, and
some jumpers with allergies claim that riding up to altitude seems to alleviate symptoms.
“As the gas expands at higher altitudes, it fills out the vacuum in the ears and sinuses that
exists in allergic people at sea level, and they feel better. But it gets worse on descent,”
says Holt. “I cannot recommend jumping with symptomatic colds or allergies unless you
can clear your ears at ground level and at altitude both.” He adds, “Medications cannot
substitute for good judgment when it comes to parachuting. If you are not well, no
medication can guarantee safety. It is best to wait until the upper respiratory conditions
are improved before jumping. The risk is too great.”
According to AAO-HNS, the common cold and allergies are the most common reasons
for a stuffy nose, but a stuffy nose can be a symptom of many different underlying
disorders. Skydivers suffering from serious or continued ear or sinus problems can find
the nearest otolaryngologist on the AAO-HNS website at www.entnet.org/index2.cfm or
by calling (703) 836-4444.
C A S E S T U D Y Cerebellar Atrophy by Karen Shuler, PT, DPT, Lifestyle Physical Therapy, Lake Wylie, SC INTRODUCTION OBJECTIVE DATA AT INITIAL EVALUATION Patient is a 65 y.o. female with a long history of seizures and declining balance over the past 3 years. Her MRI revealed cerebel ar atrophy due to prolonged use of seizure medication. The patient has fal en once over the past