Herbal Health

The case of John Browning demonstrates how people participate both in the onset of—and recovery from—illness. This case is revealing because it suggests specific connections between emotional stresses and cancer.John is a brilliant scientist who works for a world-renowned research firm. At the time of the onset of his cancer (of the pancreas), he was fifty years old. He was given a life expectancy of six to nine months. Professionally, he had always been an overachiever, but as he approached fifty, he began to face the fact that many of his childhood dreams would not be reached. Although he had received considerable professional recognition, it had not been at the level he had hoped. In effect, he was experiencing mid-life crisis.In addition, in the months prior to the onset of his cancer, John’s son went off to college. Almost every weekend for many years, John had gone to athletic events with his son. John took great pride in his son’s aptitude for sports. After his son’s departure, however, John stopped attending sports events entirely. Clearly, an era had ended.The end of this period also raised new stresses between John and his wife. His wife had not recently enjoyed sports and had not participated in the family’s many athletic pursuits. Instead, she had become involved with club work, church work, and similar activities. Since John no longer spent every weekend with his son, he and his wife were thrown together as they had not been for a long time, and they had to develop new ways of communicating and creating interests in common.Another of John’s regrets was that some years earlier he had left a university post to go to work for his present employer. His motivation had been the extra money he would earn for his son’s college education. But while his salary was indeed substantially greater, he badly missed having people to guide and instruct.A great satisfaction in his present job was that he had been able to produce a number of significant research breakthroughs by putting together a collection of scientists and guiding them into an exceptionally creative team. His supervisors had been so impressed with his performance that they put him in charge of another major project as a reward. But to John the new project felt more like a punishment than a reward, for it meant he had to leave his team. Like many of our patients, however, John had extreme difficulty expressing his feelings and never told his superiors how badly he felt about the new assignment.This inability to speak up for his needs became clear after John entered into therapy with us. He told us he had always prayed regularly, but he soon informed us that he had never prayed for his own health. John believed it would be wrong to ask for anything for himself in his prayers. These attitudes traced back to his childhood. John’s mother was, he said, “a very pious and self-sacrificing person.” John saw his father, in contrast, as a “selfish person” who accumulated money and then spent most of it on himself. John took his mother’s self-sacrificing attitude yet always believed he had inherited a selfish streak from his father.But as John rejected his father’s apparently immature and selfish behavior, he overcompensated because of his fear of being selfish. This showed up in his difficulties in communicating his needs and feelings to others, in investing his life with meaning by making himself responsible for others, and in abandoning pleasurable activities when they were not shared with his son. In short, John felt obliged to place everyone else’s needs ahead of his own, and so when his son left for school, when John was removed from his work team, when his professional dreams were unfulfilled, his personal rules were such that he could see no way to meet his needs. He thus became extremely depressed.Changing BeliefsThe first step for John, or for anyone else trying to get well, is to identify those attitudes and beliefs that lock him into a pattern of hopeless victim. The psychological reality is that if John were to hang onto his beliefs that everyone else’s needs come first, he would indeed be powerless to meet his own emotional needs. Clearly, these beliefs need to change.We worked with John to help him recognize the facets of himself he was ignoring, and also to help him change his perception in other areas in his life. As a result of those efforts, he reexamined his work situation and finally came to the understanding that his superiors had, in fact, been trying to reward him by giving him the new job assignment and had no way of knowing of his disappointment. We urged him—as we urge everyone—to take his emotional responses to life more seriously.We also worked with John on his sense of failure because he had not realized his early dreams. Like many ambitious men, John had channeled his energy into developing primarily those parts of himself related to his work. Now, since the dreams were no longer attainable, we urged him to give himself permission to explore other interests or pursue other parts of himself that had been held in check. Finally, we worked with John on his sense of loss of his son, pointing out the degree to which he had vested so much of his personal happiness in someone else rather than himself, and helped him to see that he had an opportunity to renew his relationship with his wife.None of this is meant as a criticism of John; many of us have experienced similar events and reacted similarly. The difficulty is that the beliefs John had adopted as a child in response to the conflict between his mother and father were blocking his finding alternative ways of responding to life’s inevitable disappointments. The point is that there are alternatives. Whenever people feel boxed in and trapped, it is because they are limited by their own beliefs and habitual ways of responding.*31\347\2*

Doctors know a lot about ADHD, but they are not completely certain what causes it. The current view is that the syndrome has underlying biological-neurological origins (possibly with a genetic, or inherited, component) that interact with the individual’s environment to result in the manifestation of ADHD.Previous hypotheses regarding the causes, or etiologies, of ADHD have focused on brain damage caused during pregnancy or birth; other causes of brain damage early in life, such as trauma or infections; troubled family environments; inadequate parenting; food additives; sugar in the diet; and malnutrition. It is now clear that no one of these etiologies is universally present. The question of food additives and sugar has been carefully examined in controlled studies and has been convincingly ruled out as an etiology. While some people with ADHD have undergone prenatal fetal distress or birth trauma, and while some, upon examination, show signs suggestive of brain dysfunction, others may have no such history and may have a completely normal physical examination.One of the problems with researching the possible biological causes of ADHD is the difficulty in defining just what brain functions are disturbed. Researchers have attempted to break down the function of attention into its components, which can then be studied and even localized to specific parts of the brain. For example, Dr. Alan Mirsky of the NIMH has divided attention into the following three components:1. the capacity to select a part of the environment to focus on, the ability to sustain that focus over time, andthe ability to change or shift focus, i.e., to stop focusing on one part of the environment and start focusing on another part of the environment.With the advent of positron emission tomography (PET), researchers are now trying to localize brain function while it is occurring. For example, in one study adult subjects were asked to learn a list of words while a PET scanner analyzed how much glucose different parts of their brain used while they worked. In people with ADHD, the brain areas involved in attention used less glucose than in normal control subjects.Another area of research involves the dramatic results achieved in improving some ADHD symptoms through the use of the stimulants methylphenidate (Ritalin) and dextroamphetamine (Dexedrine). Studies have shown that these stimulants increase the amount of dopaminergic neurotransmitters, the chemicals that carry electrical messages from one nerve cell to the next, available in the central nervous system. Stimulants may also increase the amount of another transmitter, norepinephrine, in the parts of the brain related to activation and arousal. However, the impact of these stimulants is very complex, and it does not follow that ADHD is caused by a simple deficiency in the quantity of these transmitters. What is very likely is that the underlying biological disorders somehow cause a disturbance in neurotransmitter functions. Research in this area will hopefully continue to enhance our knowledge of both the etiology and management of ADHD.From the moment of conception, the environment has an impact on the fetus. Obviously poor nutrition, absence of adequate prenatal care, metabolic and toxic factors (such as alcohol, cigarette, or drug use by the pregnant mother), infections, stress, birth trauma, premature delivery, and low birth weight can all affect the health of the newborn infant. In fact, studies have shown a correlation between these factors and later ADHD.Environmental influences become ever more complex as an individual proceeds through development after birth. While there are no firm correlations between ADHD and family and parenting variables, it is clear that from the beginning of life, the environment of these youngsters interacts in complex ways to bring about the complicated symptom picture that we call ADHD. This interplay between biology and environment will be enlarged upon in the next chapter’s discussion of ADHD at different developmental stages.For now it is clear that many different variables, including genetic, biological, and psychosocial factors, combine and interact to form the syndrome known as ADHD.*8\173\2*

 AL HEALTHSeveral types of mental health professionals, or providers, are available to help you. Most insurance companies have some type of psychiatric care provision, although the amount of coverage varies based on the policy plan and the credentials of the provider. The most important criterion when choosing a provider is whether you feel you can work well with that person, not how many degrees he or she has.

Psychiatrist
A psychiatrist is a medical doctor. After obtaining an M.D. degree, a psychiatrist spends up to
12 years studying psychosocial health and disease. As a licensed physician, a psychiatrist can prescribe medications for various mental or emotional problems and may have admitting privileges at a local hospital. Some psychiatrists are affiliated with hospitals, while others are in private practice.

Psychoanalyst
A psychoanalyst is a psychiatrist or a psychologist having special training in psychoanalysis. Psychoanalysis is a type of therapy in which a patient is helped to remember early traumas that have blocked personal growth. Facing these traumas helps the patient to resolve the conflicts they have caused and to begin to lead a more productive life.
 Psychologist
A psychologist usually has a Ph.D. degree in counseling or clinical psychology. In addition, many states require licensure. Psychologists are trained in various types of therapy, including behavior and insight therapy. Most are trained to conduct both individual and group counseling sessions. Psychologists may also be trained in certain specialties, such as family counseling, sexual counseling, or counseling related to compulsive behaviors.
Clinical/Psychiatric Social Worker
A social worker has at least a master’s degree in social work (M.S.W.) and two years of experience in a clinical setting. Many states require an examination for accreditation. Some social workers work in clinical settings, whereas others have private practices.

Counselor
The counselor often has a master’s degree in counseling, psychology, educational psychology, or a related human service. Professional societies recommend at least two years of graduate coursework or supervised practice as a minimal requirement. Many counselors are trained to do individual and group counseling. They often specialize in one type of counseling, such as family, marital, relationship, children, drug, divorce, behavioral, or personal counseling.

Psychiatric Nurse Specialist
Although all registered nurses can work in psychiatric settings, some have chosen to continue their education and specialize in psychiatric practice. The psychiatric nurse specialist can be certified by the American Nursing Association in adult, child, or adolescent psychiatric nursing.

Remember that, in most states, anyone can use the title of therapist or counselor. Before you begin treatment, you should consider the credentials of your counselor, your desired outcomes, and the expectations of you and your counselor.
When working with a client, therapists often subscribe to a primary philosophy of treatment based on their educational background and experiential training. Most, however, employ a variety of methods when helping a client, depending on the client’s needs and the therapist’s experiences in the field. Many different types of therapy exist, ranging from individual therapy, which involves one-on-one work between therapist and the client, to group therapy, in which two or more clients meet with a therapist to discuss problems.
*4/177/5*

Sexually transmitted infections are generally spread through some form of intimate sexual contact. Sexual intercourse, oral-genital contact, hand-genital contact, and anal intercourse are the most common modes of transmission. More rarely, pathogens for STIs are transmitted mouth to mouth or, even more infrequently, through contact with fluids from body sores. While each STI is a different infection caused by a different pathogen, all STI pathogens prefer dark, moist places, especially the mucous membranes lining the reproductive organs. Most of these organisms are susceptible to light, excess heat, cold, and dryness, and many die quickly on exposure to air. (The toilet seat is not a likely breeding ground for most bacterial or viral STIs!) Although most STIs are passed on by sexual contact, other kinds of close contact, such as sleeping on the sheets used by someone who has pubic lice, may also cause you to get an STI.
Like other communicable infections, STIs have both pathogen-specific incubation periods and periods of time during which transmission is most likely, called periods of communicability.
*16/277/5*

sherry squeezed in her appointment with me between Catholic Mass, where she was a lector, and the Art Alliance meeting, where she was the secretary. Every minute of her day was filled with activity, and that’s the way she liked it—always helping others, the busier the better. Yet her overscheduled life was crumbling. She could no longer shove aside the horrors that were occurring in her own mind.
Petite and blond, hippie-looking but stylish, in jeans and a shawl, she rushed into my office, yanked her chair up close, leaned in, and took a deep breath. “I’m so scared,” she confided. “I have terrible thoughts. I think of killing people. I think of stabbing my husband and my four year old, Megan. Driving over here I saw a little girl walking home from school, and I had the urge to swerve and hit her. Last night we drove by our old house, and my husband remembered that we still had the key to it. I started thinking: ‘Oh good, we could sneak in at night and stab everybody.’ I’m totally sick.
“Some days I can’t think about anything else,” she said, speaking more rapidly. “No thought is too awful for me. Sometimes I get the idea of gouging my daughter’s eyes out. I used to think about throwing her in the microwave, but she’s too big for that now, thank God. This morning I was shaving my legs in the shower, and I felt like cutting myself, slashing my neck open with a razor. I saw the blood pouring from my neck.”
She leaned back and gave me a glassy look. “God, this sounds so crazy. I don’t want to do these things I think about. At my worst moments, all I hold on to are God and Jesus. When will this hell I’m in end?” She sat quietly, wiping away tears.
I asked gently when these upsetting thoughts had started. Sherry related that she had been tormented by obsessions since age eleven, when, while baby-sitting, she had her first dreadful obsession. She was sitting on the kitchen floor, serenely watching her six-month-old niece rock back and forth in a swing set. Then, by chance, her eyes came to rest on a carving knife lying unsheathed on the kitchen counter. Suddenly, in her imagination, she grabbed it and slashed at the baby. Blood was everywhere. She froze in anguish and guilt. Her life was never the same.
Each night for a week afterward she dreamed that an evil witch had cast a spell on her mind. Finally confiding in her parents, she was taken to a therapist. A year of psychotherapy aimed at uncovering conflicts helped her feel better about herself but did not stop the tormenting images. “Why me?” she thought.
Knife fantasies continued to trouble her throughout junior and senior high school, and new obsessions cropped up as well. She learned to keep herself as busy as possible. As long as she was involved in an activity, the self-tormenting thoughts would usually leave her alone. If, however, she put herself under too much stress, then frightening thoughts would hit hard, like when she tried out for cheerleader and suffered terrifying urges to scream out obscenities at the top of her lungs. She made the team by keeping her teeth clamped together like steel traps; her jaw muscles ached for days afterwards.
In college she majored in art after discovering that her obsessions disappeared when she was fully involved in a creative task such as painting. Yet most hours of the day tormenting, violent thoughts were her secret companions. Thoughts to commit suicide were often on her mind as well. Strangely, these were usually consoling in their effect. “If my awful thoughts get too strong,” she would think, “I can always kill myself before I murder someone else.”
Her worst period ever followed the birth of her daughter. Overwhelmed by almost every awful harm obsession imaginable, including knifing, dropping, scalding, microwaving, and sexually molesting her infant, she developed a state of nervous exhaustion. She couldn’t eat or sleep and finally just stayed in bed, leaving caring for her daughter to others.
A psychiatrist was consulted, and he recommended hospitalization because of the severity of her depression. She refused. “Please God, I’ll make a deal,” she prayed. “I’ll go to the hospital if it gets really bad, but give me the strength to fight the thoughts.” She began to see the doctor for psychotherapy and, with the help of antidepressant medication and the support of her husband, regained the ability to cope.
But four years later, after her husband landed a new job and the family moved to Pennsylvania, her equilibrium was shattered. She was again overwhelmed by OCD.
*2/338/2*

Withdrawal  
This not very effective method of birth control is most commonly used by people who have not taken the time to consider alternatives. The withdrawal method involves withdrawing the penis from the vagina just prior to ejaculation. Because there can be up to half a million sperm in the drop of fluid at the tip of the penis before ejaculation, this method is unreliable. Timing withdrawal is also difficult; males concentrating on accurate timing may not be able to relax and enjoy intercourse.

Emergency Contraceptive Pills
There are more than 2.7 million unintended pregnancies per year in the United States, and nearly half are due to contraceptive failure. According to the Centers for Disease Control and Prevention, more than 11 million American women report using contraceptive methods associated with high failure rates, including condoms, withdrawal, periodic abstinence, and diaphragms. These facts led the Food and Drug Administration (FDA) to approve the “Preven Emergency Contraceptive Kit.”
Emergency contraception can be used when a condom breaks, after a sexual assault, or any time unprotected sexual intercourse occurs. Emergency contraceptive pills (ECPs) are ordinary birth control pills containing the hormones estrogen and progestin. Although the therapy is commonly known as the “morning-after pill,” the term is misleading; ECPs can be used up to 72 hours beyond. The use of ECPs can reduce the risk of pregnancy by 75 percent.
Emergency contraceptives require a prescription. After a woman determines she is not pregnant, by using the pregnancy test included in the kit, the first dose of two light blue emergency pills is taken as soon as possible, within 72 hours after sex with a known or suspected birth control failure or sex without birth control. The second dose is taken 12 hours later. The most common side effects related to emergency use are nausea, vomiting, menstrual irregularities, breast tenderness, headache, abdominal pain and cramps, and dizziness.
Emergency mini-pills contain progestin only. Like ECPs, mini-pills can be used immediately after unprotected intercourse and up to 72 hours beyond. Emergency mini-pills are equally as effective as ECPs, but nausea and vomiting are far less common. Emergency mini-pills are an excellent alternative for most women who cannot use ECPs that contain estrogen.

Abstinence and “Outercourse”
Strictly defined, abstinence means deliberately shunning intercourse. This strict definition would allow one to engage in such forms of sexual intimacy as massage, kissing, and solitary masturbation. But many people today have broadened the definition of abstinence to include all forms of sexual contact, even those that do not culminate in sexual intercourse.
Couples who go a step farther than massage and kissing and engage in activities such as oral-genital sex and mutual masturbation are sometimes said to be engaging in “outer-course.” Like abstinence, outercourse can be 100 percent effective for birth control as long as the male does not ejaculate near the vaginal opening. Unlike abstinence, however, outer-course is not 100 percent effective against sexually transmitted infections (STIs). Oral-genital contact can result in transmission of an STL, although the practice can be made safer by using a condom on the penis or a dental dam on the vaginal opening.
*14/277/5*

Physical therapists, respiratory therapists, and occupational therapists all help the patient intensively during the early days of hospitalization. Every patient with a spinal cord injury will work with a physical therapist. Physical therapy involves the use of physical exercises and techniques such as massage or the application of heat or ice. The physical therapist has the major responsibility for maintaining your strength and flexibility and for teaching you mobility skills. The therapist will test each body part to determine muscle function and strength, before initiating an individualized exercise program.
As you begin physical therapy, you’ll encounter different terms for the various exercises. Ranges of motion exercises are the bedrock of the therapy, and these begin immediately. Range of motion refers to the degree of flexibility of a joint and is quantified by measuring (in degrees) the joint’s limits of motion in each direction. Various exercises are used to maintain or improve range of motion. If you cannot move your own limb and the therapist does it for you, it is called passive range of motion exercise. In active range of motion exercises, you control your own movement. There are also active resistance exercises in which you move against a force with your own energy. In active assisted exercise, the therapist helps you move weakened muscles. Range of motion exercises will become part of your daily routine for the rest of your life. They prevent contracture, a condition in which soft tissues around joints shorten, stiffen, and lose flexibility, leading to a loss of joint motion.
Physical therapists also teach you or your family the proper positioning of your body and proper movement so that pressure sores or decubitus ulcers do not develop (these and other complications of spinal cord injury are discussed below). After a few days in the hospital, you’ll probably begin to sit up, and your physical therapist will be there to help with positioning.
If necessary, respiratory therapy is initiated early in your hospitalization. This therapy involves the use of machinery and the therapist’s hands to help you breathe and cough. If you are using a ventilator, respiratory therapy is essential to monitor proper use of the ventilator equipment and management of the tracheostomy. If you do not need a ventilator but your injury is above T12, you may need respiratory therapy to help keep your lungs clear of fluid, because the muscles for coughing are weakened. This therapy includes inhaling medications to help expand the small airway passages in the lungs, along with breathing exercises and techniques to help keep your lungs clear.
Occupational therapy focuses on use of the upper body, arms, and hands for self-care activities such as feeding, bathing, and dressing, and for functional activities such as writing, balancing a checkbook, and cooking. The occupational therapist may begin work on self-care activities, also called activities of daily living, in the acute phase of your treatment, but you will work more intensively with occupational therapists in the rehabilitation hospital.

*12/156/5*

The brain functions normally when there is interaction of many cells. When a sufficient number of cells work together, an “event” occurs. What the event will be is determined by which cells are firing. If the firing cells are in the motor area of the brain, the event may be the movement of a finger, hand, or foot; if it is in the sensory area, it may be a feeling like a tingle or a burning. In other areas it may be a taste, or a smell, or a memory. These normal human experiences occur when specialized parts of the brain are sufficiently excited.
A seizure occurs when the balance between excitation and inhibition is lost. A motor seizure, for example, happens when a sufficient number of cells spontaneously fire together and produce a sudden movement, a jerk. Not all sudden movements are seizures. A seizure is usually the result of repetitive firing of these same cells; when in the motor area repetitive firing leads to the rhythmic, repetitive jerking of a group of muscles.
Other types of seizures occur when cells from other areas of the brain fire simultaneously. The type of seizure depends on how many cells fire and which area of the brain is affected.
*12\208\8*

The limiting levels of blood pressure are arbitrary. They are based on a population whose blood pressures are too high in the first place. When a diastolic blood pressure is between 90 and 100 millimeters of mercury, the blood pressure is said to be borderline. When the diastolic lies between 100 and 110 millimeters of mercury, it is said to be mildly elevated and when the diastolic blood pressure is between 110 and 120 millimeters of mercury, the blood pressure is said to be moderately elevated. The term malignant blood pressure is used when diastolic blood pressure exceeds 120 millimeters of mercury or the systolic climbs above 200. At this point in time signs of active retinal, cerebral or kidney damage occur right before the physicians eyes.
Medication in the management of high blood pressure is the beginning of a statistical nightmare. A normal blood pressure may mean that in ten years time, ten people in a thousand will die of cardiovascular disease. An elevated blood pressure could mean that 20 people will die in the next ten years as a result of cardiovascular disease. It follows that to save ten lives in a thousand people, 990 of them are going to be placed on medication that were never going to have a serious complication of high blood pressure in the first place. Medical science is unable to be more selective than this when deciding who to put on medication for high blood pressure.
Considering that in one sub group of the Framingham study more people treated with Fluid Tablets for high blood pressure died than people that remained untreated, there is room to question the use of potent chemicals in the management of high blood pressure. Most doctors would agree that people with malignant blood pressure are best treated on the spot. Death is imminent and the side effects of drug therapy become irrelevant.

Home Remedies
The treatment of high blood pressure is something of a headache. People with border line blood pressure are advised to drink less alcohol, lose weight, eat less salt and exercise more. Done in moderation these activities have the potential to lower the blood pressure by 10 millimeters. In other words, the diastolic blood pressure is taken into the normal range. If the blood pressure is over a 100 millimeters (diastolic), these interventions are never going to take the blood pressure back into the normal range and so medication is advised by the medical practitioner.

*7/131/5*

Quick, simple action can save a life
Thousands of Americans choke to death needlessly every year. People of any age can choke on pieces of food, vomit and small objects.

Prevention
For yourself
Take small bites and chew food thoroughly. Cut meat into small pieces.
Don’t eat too fast, or eat and talk or laugh at the same time.
Don’t drink too much alcohol before eating.
If you smoke, wait until after you’ve finished eating to light up.

If you’re a parent of a small child
Keep small objects that children might choke on out of reach.
Do not let children run or jump with food or any other object in their mouth.
Inspect all toys for small, removable parts that can cause choking. (Follow label guidelines that indicate “appropriate ages.”)

What you can do      
if someone is choking
You may have only four to eight minutes to save a choking person’s life, so you should know how to administer the Heimlich maneuver and CPR.
A conscious child or adult who is choking will breathe in an exaggerated way. They will be unable to talk or cough, and will probably nod in the affirmative to the question, “Are you choking?” They may grasp their throat. People who can cough or speak are still getting some air into their lungs, and should be encouraged to cough vigorously. The Heimlich maneuver should not be administered in these cases.

Choking rescue (heimlich maneuver) for a conscious person
Establish whether the person can speak or cough by asking, “Are you choking?”
Stand behind the person.
Wrap your arms around their waist.
Grasp one of your fists with the other hand and place the thumb-side of the fist just above the navel but below the rib cage.
Thrust your fist upward in five quick, sharp jabs.
Repeat until the object is dislodged or the person becomes unconscious.

Choking rescue for an unconscious person
Call 911 or your local emergency services number.
Check for object in the mouth by using tongue-jaw lift (see Figure 9) and sweeping deeply with a hooked finger to remove object.
Open airway (push down and back on the forehead and lift up the chin by placing your fingers on the jaw bone). Attempt rescue breathing by pinching the nostrils shut, placing your mouth over the . person’s mouth, and giving two breaths. If needed, open the airway and try again.
If object is still obstructing airway, kneel down and straddle either the person’s hips or legs.
Place the heel of one of your hands against the person’s abdomen just above the navel but well below the rib cage, then place your second hand on top of the first.
Press into the person’s abdomen with quick upward thrusts. Do this five times.
Repeat sequence of finger sweep, rescue breathing attempt and abdominal thrusts until successful or until help arrives.
Obstructed airway in children 1 to 8 years old
Use same procedure already covered with two important exceptions:
Look into the airway and use your finger to sweep the object out ONLY if you can see it. DO NOT perform a blind finger sweep. Instead, perform a tongue-jaw lift.
If obstruction is not relieved after one minute, call your local emergency services number. Of course, if someone else is available, have that person call for help immediately. Continue sequence until successful or until help arrives.

Obstructed airway in infant or child less than 1 year of age
The following steps are appropriate if there is complete airway obstruction due to a witnessed or strongly suspected obstruction by an object. DO NOT PERFORM these maneuvers to clear an airway that is obstructed due to swelling caused by infection. SEEK EMERGENCY CARE IMMEDIATELY.
Infant or child is conscious
Hold infant or child face down along your forearm, supporting the head and neck with one hand.
Give five back blows forcefully between the shoulder blades with the heel of your hand.
Turn the infant or child face up. Keeping the head supported and lower than the rest of the body, position your index and middle fingers on the baby’s breastbone and give five thrusts with two fingers.
Do chest thrusts slower than you would for CPR.

Repeat until the object is dislodged or infant/child is unconscious. Infant or child is unconscious
Place the infant or child on a firm surface.

Open the airway (push down and back on the forehead and lift up the chin by placing your fingers under the jaw bone). With an infant, be careful not to extend the head back too far since that can shut off the airway.
If the infant or child is not breathing, try to give rescue breaths by covering his or her mouth and nose with your mouth.
If unable to give breaths, reposition the head and try again.
Turn child face down and deliver five back blows.
Deliver five chest thrusts.
Do tongue-jaw lift. Remove object ONLY if you can see it.
Try again to do rescue breathing.
Repeat back blows, chest thrusts, tongue-jaw lift and rescue breathing attempts until successful.
After one minute of emergency first aid, call 911 or your local emergency services number. Of course, if someone else is available, have that person call for help immediately. Continue process until successful or until help arrives.
If you are choking and can’t get help
Try not to panic.
Cough vigorously.
If unsuccessful, stand behind a chair or beside or over some other object that puts pressure on your abdomen just above your navel (but below your rib cage).
Thrust yourself upon the object in strong, sharp bursts.
Repeat until item is dislodged.

For a pregnant or obese person
Stand behind the person and place your arms under their armpits.
Place fist on the middle of breastbone in the chest, but not over the ribs. 
Place other hand on top of it.
Give five quick, forceful movements. Do not squeeze with arms, but use your fist.
Final notes 
Call your local hospital or Red Cross chapter for more information and instruction on these procedures. Those who have just had the choking rescue performed on them should see a doctor. The maneuver can cause trauma to the chest or abdomen, and the object may have damaged the throat.
*2\303\2*