When I first begin working with survivors of strangulation, I was not surprised to hear them report about the development of persistent and chronic neck pain. What amazed me was hearing these same survivors report how they developed asthma after their assaults.

One nurse manager in a forensic medical unit told me in a casual conversation that she was amazed how many women showed up in her unit clutching an ever-present asthma inhaler in their hands.

What if the problem of "acute asthma attacks" in these survivors reflects not a problem in the chest, but a problem in the neck? And what if the persistent neck pain were related to the "asthma?"

Fractures of the larynx are reported in the medical literature following strangulation assaults. However, this occurs mostly in fatal strangulation attacks or in patients in whom the strangulation was from a form of hanging and not from manual strangulation, which is the form of strangulation reported in 97% of IPV strangulation assault survivors.

And what if fractures of the larynx did occur often in manual strangulation assault but could not be detected in the early stages of recovery?

An article in eMedicine notes, "Manual strangulation is a low-velocity, high-amplitude injury that commonly results in multiple fractures without significant displacement of cartilage, early presentation of hematoma, or endolaryngeal mucosal tears." [1] In other words, patients can present to the hospital with no or few findings seen at the time of their arrival. However, persistent symptoms may appear later and cause the patient to have long-standing health consequences from the strangulation assault.

This could be the perfect breeding ground for paradoxical vocal cord dysfunction, a condition that can be caused by trauma or be related to working/living situations.

To learn more about paradoxical vocal cord dysfunction related to working or living situations, check out the report filed by Pittsburgh medical editor Marilyn Brooks by clicking here.

More information about paradoxical vocal cord dysfunction can also be found on the website of the Everett Clinic. Click here to access this additional data.

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[1] Pancholi SS. Laryngeal Fractures from eMedicine Web MD website. Visit http://www.emedicine.com/ent/topic488.htm. Accessed February 25, 2008.

Whether you are a survivor of trauma or abuse or a professional supporting survivors, you no doubt have many, many stories to tell. Perhaps you have thought, "I should write a book." Or friends and family have said, "You need to write a book!"

Either way, make the leap from talking stories to writing stories by joining us in Half Moon Bay, CA this coming April.

From the course announcement:

Save Saturday, April 19th, or Thursday, April 24th, 2008, to attend a one-day workshop at Cameron's Inn at The Outback. 1410 S. Cabrillo Highway, Half Moon Bay, CA. Choose to attend whichever day works best in your schedule or elect to attend both days to experience the same material with a different group of attendees.

The $95.00 fee includes lunch.

In the first quarter of 2008, our address-in-the-cyberspace will be moving to another server.

Towards this end we will be sending you several emails asking you to "opt in" or stay subscribed to the eZine by clicking a link and signing up for the eZine again.

We apologize for whatever inconvenience this causes you. However, in the long-run, life will be better!

If you do not wish to keep getting this eZine, then just ignore these email invites.

If you want to continue getting this newsletter, you do not have to wait for the email invite. You can just click below and sign up now.

From time to time, I am asked to serve as an expert witness for an IPV case involving manual strangulation. When my schedule does not permit my doing so, the second question is always, "Can you recommend someone?"

The answer to that question is always yes. The list of health providers who have the expertise to serve as an expert witness involving IPV strangulation is short but growing.

If you, or a physician or nurse you know is available to serve in such a role, please contact Dr T at DrTSpeaks@gmail.com.

Meanwhile, please note that Dr. George McClane is once again available to serve as an expert witness from time to time. You can contact Dr. McClane via his website.

I have had the opportunity to attend this conference twice. You will find it to be an excellent opportunity to learn with a wide assortment of providers in the beautiful Longview WA area. Comfortable setting, good food, and excellent staff and volunteers. Here is their announcement:

Justice and Hope March 20, 2008 Lower Columbia College SAVE THE DATE For more information: Call Chere Weiss at (360) 225-4768 Or email at cweiss@lowercolumbia.edu

The Department of Pediatrics of the University of Illinois College of Medicine at Peoria (UICOMP) and Children's Hospital of Illinois (CHOI) have initiated a national search to identify candidates for an opening as Medical Director of a well-established child abuse program.

The new UICOMP Medical Director will join an experienced team in the Pediatric Resource Center that is made up of an Executive Director, physicians, experienced social service personnel (case coordinators), and administrative support staff. This is an academic position with UICOMP requiring provision of clinical services, teaching, scholarship and advocacy. The candidate responsibilities include evaluation of children for possible physical abuse, sexual abuse, and neglect; providing leadership to other Illinois health care professionals on child abuse matters; teaching of medical students, residents, attending physicians, nurses and other non-medical members of the multi-disciplinary team; and preparation and testimony in court cases. Although not required, an interest in development of a clinical research program would be viewed positively.

The candidate should be a board-certified or board-eligible pediatrician. The compensation package and academic rank will be competitive and commensurate with experience and the responsibilities of the candidate within the division.

Please contact Jennifer Schaulin at (972) 768-5350 or via email at jennifers@millicansolutions.com for more details.

All inquiries and referrals will remain confidential without your prior approval. Thank you in advance for your time and consideration. The University of Illinois is an Affirmative Action/Equal Opportunity employer

The University of Illinois is an Affirmative Action/Equal Opportunity employer.

For those of you who enjoyed last eZine's Classical Smile, here is another video showing how to have fun while creating a harmonious workplace... DrT