Mushroom Poisoning | Definition | Description | Causes and symptoms | Treatment
Definition
Mushroom poisoning refers to the severe and often deadly effects of various toxins that are found in certain types of mushrooms. One type known as Amanita phalloides, appropriately called "death cap," accounts for the majority of cases. The toxins initially cause severe abdominal cramping,vomiting, and watery diarrhea, and then lead to liver and kidney failure.
Description
The highest reported incidences of mushroom poisoning occur in western Europe, where a popular pastime is amateur mushroom hunting. Since the 1970s, the United States has seen a marked increase in mushroom poisoning due to an increase in the popularity of "natural" foods, the use of mushrooms as recreational hallucinogens, and the gourmet qualities of wild mushrooms. About 90% of the deaths due to mushroom poisoning in the United States and western Europe result from eating Amanita phalloides. This mushroom is recognized by its metallic green cap (the color may vary from light yellow to greenish brown), white gills (located under the cap), white stem, and bulb-shaped structure at the base of the stem. A pure white variety of this species also occurs.Poisoning results from ingestion of as few as one to three mushrooms. Higher death (mortality) rates of more than 50% occur in children less than 10 years of age.
Causes and symptoms
Poisonous mushrooms contain at least two different types of toxins, each of which can cause death if taken in large enough quantities. Some of the toxins found in poisonous mushrooms are among the most potent ever discovered. One group of poisons, known as amatoxins, blocks the production of DNA, the basis of cell reproduction. This leads to the death of many cells, especially those that reproduce frequently such as in the liver, intestines, and kidney. Other mushroom poisons affect the proteins needed for muscle contraction, and therefore reduce the ability of certain muscle groups to perform.
Symptoms of Amanita poisoning occur in different stages or phases. These include:
· First phase. Abdominal cramping, nausea, vomiting, and severe watery diarrhea occur anywhere from 6-24 hours after eating the mushroom and last for about 24 hours. These intestinal symptoms can lead to dehydration and low blood pressure (hypotension).
· Second phase. A period of remission of symptoms that lasts 1-2 days. During this time, the patient feels better, but blood tests begin to show evidence of liver and kidney damage.
· Third phase. Liver and kidney failure develop at this point and either lead to death within about a week or recovery within 2-3 weeks.
Other symptoms are due to either a decrease in blood clotting factors that leads to internal bleeding or reduced muscle function, with the development of weakness and paralysis.
Diagnosis
In most cases, the fact that the patient has recently eaten wild mushrooms is the clue to the cause of symptoms. Moreover, the identification of any remaining mushrooms by a qualified mushroom specialist (mycologist) can be a key to diagnosis. When in doubt, the toxin known as alpha-amantin can be found in the blood, urine, or stomach contents of an individual who has ingested poisonousAmanita mushrooms.
Treatment
It is important to remember that there is no specific antidote for mushroom poisoning. However, several advances in therapy have decreased the death rate over the last several years. Early replacement of lost body fluids has been a major factor in improving survival rates.
Therapy is aimed at decreasing the amount of toxin in the body. Initially, attempts are made to remove toxins from the upper gastrointestinal tract by inducing vomiting or by gastric lavage (stomach pumping). After that continuous aspiration of the upper portion of the small intestine through a nasogastric tube is done and oral charcoal (every four hours for 48 hours) is given to prevent absorption of toxin. These measures work best if started within six hours of ingestion.
In the United States, early removal of mushroom poison by way of an artificial kidney machine (dialysis) has become part of the treatment program. This is combined with the correction of any imbalances of salts (electrolytes) dissolved in the blood, such as sodium or potassium. An enzyme called thioctic acid and corticosteroids also appear to be beneficial, as well as high doses of penicillin. In Europe, a chemical taken from the milk thistle plant, Silybum marianum, is also part of treatment. When liver failure develops, liver transplantation may be the only treatment option.
Prognosis
The mortality rate has decreased with improved and rapid treatment. However, according to some medical reports death still occurs in 20-30% of cases, with a higher mortality rate of 50% in children less than 10 years old.
Prevention
The most important factor in preventing mushroom poisoning is to avoid eating wild or noncultivated mushrooms. For anyone not expert in mushroom identification, there are generally no easily recognizable differences between nonpoisonous and poisonous mushrooms. It is also important to remember that most mushroom poisons are not destroyed or deactivated by cooking, canning, freezing, drying, or other means of food preparation.
Resources
OTHER
"Alerts from the CDC." Experience Lab Page. 〈http://www.medsitenavigator.com〉.
"Cyclopeptide-Containing Mushroom Toxicity." The Toxikon Multimedia Project Page.〈http://www.uic.edu/com/er/toxikon/mushroo.htm〉.
"Mushroom Poisoning in Children." American Association of Family Physicians.〈http://www.aafp.org/patient-info/mushroom.html〉.
Mushroom Toxins from the FDA. 〈http://vm.cfsan.fda.-gov/∼mow/chap40.html〉.
Music Therapy
Definition
Music therapy is the clinical use of music or music-making to assist the physical, spiritual, cognitive, or social needs of individual patients or groups. It can be used with people of all ages and in a wide variety of settings ranging from outpatient clinics and rehabilitation centers to schools, hospices, and prisons. In addition, music therapy can be used with healthy individuals for relaxation or stress reduction. The National Center for Complementary and Alternative Medicine (NCCAM) classifies music therapy as a form of energy therapy as well as a mind-body intervention.
Purpose
Music therapy has been shown to be an effective adjunctive form of treatment for the following conditions:
· Pain management and reduction. Music therapy is used in dentists' and pediatricians' offices to reduce the need for local anesthesia during uncomfortable outpatient procedures. It is also used for women in labor and cancer patients.
· Communicating strong feelings and/or improving communication skills. Because the ability to respond to music does not depend on verbal skills, level of education, or formal training in music, music can be used to help children with learning difficulties find a way to express themselves. It has also been used with rape survivors or others diagnosed with posttraumatic stress disorder to explore and release strong feelings associated with the traumatic experience.
· Improving physical coordination and range of motion. Music therapy is part of many rehabilitation programs for stroke patients, injured athletes, and patients who have had hip or knee surgery. In addition, music is used as background accompaniment in most forms of movement therapy.
· Relief of depression, fear, and anxiety. Music therapy can be used as part of the treatment of major depression and anxiety disorders. It has also been shown to benefit patients with schizophrenia.
· Sensory stimulation. Music therapy is used in nursing homes and hospices with patients who may have visual, memory, speech, or mobility impairments. Many patients with Alzheimer's can remember and respond to music from their youth when they can no longer speak or recognize caregivers.
· Healing of specific organs. Since the 1920s, some music therapists have practiced sound energy therapy, a treatment based on the notion that specific sound frequencies resonate with certain organs in the body to bring about healing.
· Spiritual nurture and growth. Chanting or singing is a part of many religious traditions, including Christianity, Hinduism, Tibetan Buddhism, Sikhism, and Native American religions.
Precautions
Music therapy should be done only by a certified music therapist.
Description
Music therapy has a long history. The Old Testament describes King Saul as finding relief from his mood disorder through listening to David's harp music. The Greek philosopher Plato (c. 400 b.c.) discussed the power of music to either encourage or weaken soldiers preparing for battle by the moods it conveyed. Medieval church musicians thought of the various modes of Gregorian chant as arousing or expressing such feelings as tearfulness, joy, seriousness, or warm devotion. Modernmusic therapy began shortly after World War II, when it was used to treat emotionally disturbed veterans. The first degree program in music therapy was started at Michigan State University in 1944.
Several theories have been advanced to explain the therapeutic effects of music:
· Music directly affects the autonomic nervous system, which controls such body functions as heart rate, breathing rate, digestion, and perspiration. Soft music with a slow tempo has been shown to lower blood pressure and slow heart rate.
· Music is thought to activate the right hemisphere of the brain and improve communication between the right and left hemispheres.
· Music may stimulate the release of endorphins, chemicals produced by the body that reduce sensitivity to pain and improve mood.
· Music may temporarily block the nerve endings in the spinal cord that transmit pain messages to the brain.
Music therapy is usually tailored to the needs and interests of an individual patient. Almost any style, period, or form of vocal or instrumental music can be used. The therapist may emphasize one or more of such aspects of music as tempo, pitch, rhythm, melody, or harmony. The American MusicTherapy Association (AMTA) lists four basic methods of music therapy:
· Receptive. In this method, the patient listens or responds to live or recorded music. The receptive approach is the one most commonly used in pain management, stress reduction, and movement or dance therapy.
· Improvisation. The patient creates music spontaneously with voice or instruments. This method is used to stimulate creativity, release energy, or help the patient manage painful feelings. Drumming is a popular form of improvisation, particularly with younger patients.
· Recreative. The patient and therapist together sing or play previously composed music. This form of music therapy can also be used very effectively with groups.
· Composition. The patient is encouraged to write original songs or instrumental pieces. This approach is often used with children and adolescents to encourage a sense of competence and achievement as well as express feelings.
Preparation
A music therapist will usually meet with the patient and his or her treatment team to evaluate the patient's needs and plan the treatment before beginning therapy.
Complications
No complications from music therapy have been reported as of the early 2000s.
Results
Music therapy has been found to be an effective and low-cost treatment for acute or chronic pain, depression and other mood disorders, some types of learning difficulties, and social isolation. It has also been found to relieve stress and improve mood in hospital staff and other caregivers as well as patients.
Health care team roles
The increased willingness of HMOs as well as Medicare and Medicaid to pay for the cost of musictherapy means that more and more health care teams will include music therapists. It is estimated that about 20 percent of music therapists receive third-party reimbursement for their services as of 2005.
Music therapists usually work together with a patient's treatment team, although some work for agencies that provide in-home care while others maintain private practices. To be certified as amusic therapist, a candidate must complete a bachelor's or higher degree in music therapy from an approved college or university program as well as 1,200 hours in clinical training followed by a supervised internship. They must then pass a certification examination. Clinical training in musictherapy includes instruction and practice in working as part of a medical, psychiatric, or special education treatment team.
NCCAM is conducting two clinical trials of music therapy as of 2005, for patients receiving chemotherapy for leukemia or non-Hodgkin's lymphoma, and for recipients of bone marrow transplants.
KEY TERMS
Adjunctive— Additional or helpful. Music therapy is an example of an adjunctive form of treatment.
Autonomic nervous system— The part of the human nervous system that controls such body functions as respiration, pulse rate, digestion, and others that are not under conscious control.
Endorphins— Chemicals produced by the pituitary gland and hypothalamus that function as natural painkillers. Music therapy is thought to stimulate the production of endorphins.
Improvisation— Making or creating music without previous preparation.
Sound energy therapy— A form of music therapy that holds that specific sound frequencies can resonate with certain body organs to promote healing.
Resources
BOOKS
Dossey, Larry, MD. Healing Beyond the Body: Medicine and the Infinite Reach of the Mind. Boston and London: Shambhala, 2001.
Pelletier, Kenneth, MD. The Best Alternative Medicine, Chapter 2, "Sound Mind, Sound Body: MusicTherapy." New York: Simon & Schuster, 2002.
Woodham, Anne, and David Peters. Encyclopedia of Healing Therapies. New York: DK Publishing, Inc., 1997.
PERIODICALS
Burns, D. S., R. B. Sledge, L. A. Fuller, et al. "Cancer Patients' Interest and Preferences for MusicTherapy." Journal of Music Therapy 42 (Fall 2005): 185-199.
DeLoach Walworth, D. "Procedural-Support Music Therapy in the Healthcare Setting: A Cost-Effectiveness Analysis." Journal of Pediatric Nursing 20 (August 2005): 276-284.
Gold, C., T. O. Heldal, T. Dahle, and T. Wigram. "Music Therapy for Schizophrenia or Schizophrenia-Like Illnesses." Cochrane Database of Systematic Reviews April 18, 2005: CD004025.
Good, M., G. C. Anderson, S. Ahn, et al. "Relaxation and Music Reduce Pain Following Intestinal Surgery." Research in Nursing and Health 28 (June 2005):240-251.
Hilliard, R. E. "Music Therapy in Hospice and Palliative Care: A Review of the Empirical Data."Evidence-Based Complementary and Alternative Medicine 2 (June 2005): 173-178.
Kemper, K. J., and S. C. Danhauer. "Music as Therapy." Southern Medical Journal 98 (March 2005): 282-288.
ORGANIZATIONS
American Music Therapy Association (AMTA). 8455 Colesville Road, Suite 1000, Silver Spring, MD 20910. (301) 589-3300. Fax: (301) 589-5175. 〈www.musictherapy.org〉.
National Center for Complementary and Alternative Medicine (NCCAM). P. O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226. Fax: (866) 464-3616. 〈http://nccam.nih.gov〉.
World Federation of Music Therapy (WFMT). Office: Berklee College of Music, 1140 Boylston Street, Boston, MA 02215-3693. 〈http://www.musictherapyworld.de〉.
OTHER
Music Therapy Today. Official Journal of the World Federation of Music Therapy, available online at 〈http://www.musictherapyworld.de/index.html〉 as PDF files for download.
