Generally, it’s a bad idea to swallow things that aren’t food and drink. Sure, some things may pass through without incident, and there may even be some exceptions. Like medicine! But you never know what might be dangerous enough to taint your very blood… If you get my point. Today’s episode will deal with medical issues arising from swallowing inedible material. We’re not doctors. If you accidentally swallow anything that isn’t food, please seek the appropriate medical help from your local clinic or hospital. And with that out of the way… Let’s get into it! Hey, hey my man, I just—I just finished my salad. How are my teeth? Smile. You look fine—lettuce. Uh you got a little lettuce in your teeth. Oh- uh, h-here, lemme get it out… Toothpicks, the sharpened wood splinters that most of us don’t really think about. That's true I don't think about them... Where is this going!? You’ve likely even seen one between the teeth of countless toughs in movies. Aside from keeping a nice club sandwich held together or cleaning food bits stuck between teeth, historically, chewing on a toothpick has been viewed as a sign of contentment and insouciance—a fancy word which here means “a casual lack of concern”. But maybe there’s a different image toothpicks should bring to mind when we see them. Something like… poisoning your blood? A 33-year-old man got up for a late night snack, only to suffer from abdominal pain for the next two months. X-ray scans showed nothing that could be causing the issue, but an ultrasound scan showed a small, linear shadow. A little line near the left liver lobe. Brought in for an exploratory surgery, doctors found something in the man’s body that really shouldn’t have been there. Who’s that Pokémon? A small, spikey, wooden, almost pick-like- It’s a toothpick! God. It’s obvious, just get to it. Ah, yes, it was a toothpick that had managed to pierce through the man’s intestinal lining, surrounded by inflammation. After removal, the patient made an unremarkable recovery, and when asked about the toothpick, he stated that he probably ingested it following a night of drinking. A middle aged woman was admitted to her local hospital with tenderness in the abdomen over her stomach. No problem was found until she was transferred to a hospital where blood work was done. Finding the results unusual, the staff took a CT scan of the woman’s abdomen and found a small, linear shadow. One with surrounding inflammation. Another toothpick? Another toothpick. It had punctured the woman’s innards after being swallowed, and had gotten stuck. After removal, the woman had an uneventful recovery. But when it comes to swallowing a toothpick, just having it get stuck inside you is probably one of the better outcomes possible. In 2012, the British Medical Journal reported on a 45-year-old woman whose inadvertent consumption of a toothpick had much worse effects on her than mere abdominal pain. Admitted to the hospital with symptoms including generalised gut pain, fever, nausea, vomiting, and low blood pressure. These, of course, were caused by an accidentally swallowed toothpick. It had proceeded to perforate her gullet, a fancy word which here means “the throat”. Now my script goblin couldn’t find a mention of it moving into the digestive system after perforating the gullet, so it may have just skipped the digestive system all together and made its way through the body another way. Which… Ohh, that sounds painful! And it only got more painful, too! Oh no! Oh yes. The woman’s state deteriorated during her time in the hospital. While the toothpick once more didn’t show up on the X-Ray, an abdominal ultrasound revealed the pointed stick lodged in a lobe of her liver— and a liver abscess. Oh… Oh no. What’s an abscess mean? I’m so glad you asked. An abscess, as described by the National Health Service, is a “painful collection of pus”. These are usually a result of bacterial infections, specifically when your immune system sends white blood cells to attack the infection. As the battle between white blood cells and bacteria rages on, tissue around the infection dies, creating a hole that is then filled with pus—thus becoming an abscess. Gag sound. Regurgitating. I mean, the human body is a complicated thing, Howard. You humans make me sick. This is kind of like accidentally including an update that burned a hole in your motherboard, and then your operating system filled it with coffee grounds. I don’t need updates. The woman also went on to develop breathing issues, and later systemic infection via blood poisoning—that is to say that the bacteria hitching a ride on the toothpick spread after entering her body and reached her bloodstream going on to infect the rest of her body. While “blood poisoning” isn’t medical terminology, it’s still a serious condition. Once a bacterial infection reaches the bloodstream it can cause further complications, like sepsis in which the body’s immune system releases an unbalanced level of chemicals into the bloodstream which can damage organs. Sepsis can also progress into septic shock, which causes a dramatic drop in blood pressure, and is life threatening. Thankfully, in this case, the woman was able to be treated effectively with antibacterials, and the toothpick was removed via an operation called “keyhole surgery”, also known as “laparoscopy” or “minimally invasive surgery”, which is an operation using a small incision and a tube with a camera and light source, generally used for the pelvis or abdomen to perform surgeries without needing large incisions. Ok, so if you accidentally swallow a toothpick it can be pretty bad, but how common can instances like these be? Yeah, judging by the sheer amount of clearly inedible items with “do not swallow” warnings on them, I’m gonna go with depressingly common. And you’d be right. Lovely. “Foreign body ingestion”, aka eating things you shouldn’t, is most commonly seen in children but also occurs with adults. Typically these foreign bodies that adults accidentally ingest are limited to things that can be eaten with food, namely chicken or fish bones, though toothpicks are also common enough that a German study looked at 136 incidents where adults also ingested them. And while according to one study, most foreign body ingestion cases will pass on their own and be expelled through the excretory system. Normally, these can be treated solely through observation - that is, watching the patient to make sure their condition doesn’t deteriorate - they can be extremely dangerous when complications arise. In fact, the complications can even be life threatening, such as in the case of an 18-year-old athlete. In his case, the toothpick poked into the wall of his large intestine which let bacteria reach and infect his blood stream, and caused a life threatening case of blood poisoning. Doctors managed to remove the toothpick after finding it in a colonoscopy and treated him with antibiotics, but like the other cases, X-rays didn’t pick up on the toothpick, and also like the others, he didn’t remember ingesting it. Yeah, didn’t think I’d ever have to ask this but, how does someone not remember swallowing a toothpick? Yeah, I don’t know. That seems like something you might recall or at least feel. They’re pointy! Well, in this case the toothpick came from a sandwich and according to one study, most people who swallow toothpicks are either edentulous, a fancy word which here means “lacking teeth”, alcoholic, or used to picking their teeth. When it comes to people who suffer from alcoholism, they may not notice the toothpick due to being inebriated at the time. But, um, what about the other two things? Well, we don’t really have as much info on those, but it could be that they accidentally ingest it with food. This is just a guess, but I could see someone lacking teeth trying to use a toothpick to clean chewed up food from their gums, and those who regularly use toothpicks may chew on them after picking their teeth. Either way, an inhale at the wrong moment, or absentmindedly eating and picking your teeth could lead to ingestion of the pick, unnoticed along with food. Kind of like when you accidentally swallow your chewing gum? Yes, more or less. But if you do realize that you’ve swallowed a toothpick or any other inedible pointy object, it’s probably best to head straight to the Emergency Room. Dr. Troy Madsen of University of Utah Hospital advises that, “Either these things are going to be too big to be able to pass through your intestines, or they're going to be sharp and potentially perforate the intestines.” And either way, that’s probably not a risk you want to take. At the end of the day, it’s probably best that you pay attention to the things that you’re putting in your mouth, and keep yourself from being in a situation where you might swallow anything that could be harmful. So, does that mean I shouldn’t use toothpicks anymore? I don’t think that’s necessary, but some people don’t use toothpicks at all. Just—if your toothpick goes missing and you start to feel pain in your abdomen, or a fever, maybe see a doctor. Better yet, don’t ingest toothpicks. Otherwise? You may wind up on the pointy end. Oof, geez Yeah? That one didn’t hit? Well, they can’t all be wieners. Ugh Brew, oh? Get it, because you put party wieners on toothpi- Are those party wieners? Can I have one?
