Body Modification and You: Rescue Me conference, 2006

Revision Information Last revised 10-20-06 For more information contact: Steve Cole [email_address]

Last revised 10-20-06

For more information contact:

Steve Cole

[email_address]

WARNING This presentation will discuss in detail a lifestyle different from your own, and will contain slides of a graphic and adult nature. The purpose of this presentation is not to shock or offend, but to educate and facilitate better patient care. Every effort has been made to chose slides based on their medical merit, especially those showing genitals and similar features.

This presentation will discuss in detail a lifestyle different from your own, and will contain slides of a graphic and adult nature.

The purpose of this presentation is not to shock or offend, but to educate and facilitate better patient care.

Every effort has been made to chose slides based on their medical merit, especially those showing genitals and similar features.

Dealing with piercings can be a pain in our butt

Objectives Understanding of people who undergo body modification so as to better interact with them in time of crisis. Identify basic types of Body Modification Identify common medical problems with body modification Successfully remove piercings that interfere with pt care.

Understanding of people who undergo body modification so as to better interact with them in time of crisis.

Identify basic types of Body Modification

Identify common medical problems with body modification

Successfully remove piercings that interfere with pt care.

I never wanted to be different , I just wanted to be me…

Brief introduction to Body Modification and its Culture Reasons Aesthetic Social Acceptance Rites of passage Social markings Identification Rebellion Sexual Enhancement Religious Reasons Others The Romans used their nipple rings to attach cloaks to. Certain primitive tribes used piercings to mimic their prey.

Reasons

Aesthetic

Social Acceptance

Rites of passage

Social markings

Identification

Rebellion

Sexual Enhancement

Religious Reasons

Others

The Romans used their nipple rings to attach cloaks to.

Certain primitive tribes used piercings to mimic their prey.

Basic Types Tattoos Scarring and Branding Piercing Temporary Superficial Pocketing Deep Implants Incisions, amputations and other modifications

Tattoos

Scarring and Branding

Piercing

Temporary

Superficial

Pocketing

Deep

Implants

Incisions, amputations and other modifications

Mental Hold Issues There have been cases of patients being referred to mental health agencies for self mutilation Mainly for scarring, branding, and temporary piercing. The difference between self mutilation and body modification is INTENT . Other factors: Age of consent Desired outcome (changing sex, etc vs. body adornment)

There have been cases of patients being referred to mental health agencies for self mutilation

Mainly for scarring, branding, and temporary piercing.

The difference between self mutilation and body modification is INTENT .

Other factors:

Age of consent

Desired outcome (changing sex, etc vs. body adornment)

Who can do this? Home Piercings are common because of a lack of safe, certified piercers to go to for the higher risk piercings. Legality Idaho Elsewhere Certifications Associations of Professional Piercers www.safepiercing.com

Home Piercings are common because of a lack of safe, certified piercers to go to for the higher risk piercings.

Legality

Idaho

Elsewhere

Certifications

Associations of Professional Piercers

www.safepiercing.com

The Patients View Fear of: Ridicule by Medical providers Unnecessary removal Be prepared to justify your desire to remove any jewelry Fear of piercings healing closed. This leads to reluctance by patients to seek medical help for piercing problems.

Fear of:

Ridicule by Medical providers

Unnecessary removal

Be prepared to justify your desire to remove any jewelry

Fear of piercings healing closed.

This leads to reluctance by patients to seek medical help for piercing problems.

The Piercers View If the pt didn’t go to a professional piercers, they would do it in their homes If more doctors were body art friendly, then the high risk piercings could be done safer in a clinic setting.

If the pt didn’t go to a professional piercers, they would do it in their homes

If more doctors were body art friendly, then the high risk piercings could be done safer in a clinic setting.

The Cutter and the Underground Not talking about the person who constantly self mutilates as a result of severe (usually sexual) trauma. A cutter is an underground surgical practitioner. When contacted through the correct channels are willing to perform procedures such as subincision and tongue splitting (or more radical procedures) that the formal medical community is unable or unwilling to perform. Some have medical training, but some do not. Cutters almost always work illegally or at least in a gray area, so contacting a cutter is usually done through a series of anonymous and pseudo-anonymous contacts (often former clients who act as a screening service). Food for thought: Would there be cutters if the medical community was more accepting of performing body modification?

Not talking about the person who constantly self mutilates as a result of severe (usually sexual) trauma.

A cutter is an underground surgical practitioner.

When contacted through the correct channels are willing to perform procedures such as subincision and tongue splitting (or more radical procedures) that the formal medical community is unable or unwilling to perform.

Some have medical training, but some do not.

Cutters almost always work illegally or at least in a gray area, so contacting a cutter is usually done through a series of anonymous and pseudo-anonymous contacts (often former clients who act as a screening service).

Food for thought: Would there be cutters if the medical community was more accepting of performing body modification?

Piercings

“… Vanity looks best when it's wrapped in steel.” -Rev. Vain Jayne Church of Body Modification www.vainjayne .com

Standard/Surface All shapes and sizes Almost any location. Also includes Coring Stretching Pocketing Stapling Suspension piercings Flexible surgical plastic and solid bars Temporary and permanent

All shapes and sizes

Almost any location.

Also includes

Coring

Stretching

Pocketing

Stapling

Suspension piercings

Flexible surgical plastic and solid bars

Temporary and permanent

Deep Often go under or through tissues and structures. Usually flexible connection Surgical Teflon

Often go under or through tissues and structures.

Usually flexible connection

Surgical Teflon

Temporary AKA: “Play Piercing” Left in for only a short time More about the sensation than the piercing itself Often (not always) associated with BDSM or similar scenes. Temporary Piercings

AKA: “Play Piercing”

Left in for only a short time

More about the sensation than the piercing itself

Often (not always) associated with BDSM or similar scenes.

Temporary Piercings-Other Examples

Stapling and Pocketing Staples: Easy to remove Not connected Pocketing: Difficult to remove in field Look for the scar

Staples:

Easy to remove

Not connected

Pocketing:

Difficult to remove in field

Look for the scar

Surface Weaving, not pocketing

Another Example (Wolverine)

What is normal after a piercing? Some redness, and bruising normal for up to 3 days afterward. Small amounts of white , clear, or off-white drainage is normal.

Some redness, and bruising normal for up to 3 days afterward.

Small amounts of white , clear, or off-white drainage is normal.

Understanding Bad Piercings Piercing Guns Hep B/C, etc Lack of sterile tech. and equipment Infections Rejection and Migration Scar tissue/Granulation Bad Locations

Piercing Guns

Hep B/C, etc

Lack of sterile tech. and equipment

Infections

Rejection and Migration

Scar tissue/Granulation

Bad Locations

High Risk Piercings Cardiac Valve Disease Diabetes Immune suppressed Environmental or professional contra-indications Pregnancy Depending on location

Cardiac Valve Disease

Diabetes

Immune suppressed

Environmental or professional contra-indications

Pregnancy

Depending on location

Infections and Abscesses

Infections Some redness 1-3 days post piercing is normal Drainage, pus, and red streaks are not. 95% of infections are from improper care by the patient.

Some redness 1-3 days post piercing is normal

Drainage, pus, and red streaks are not.

95% of infections are from improper care by the patient.

Staph staphylococcus aureus bacteria Very common in our day to day environment. Becomes a problem when the integrity of skin is broken Causes abscess, boils, infections, and other problems with piercings. Depending on location of piercing may cause major problems to adjacent structures.

staphylococcus aureus bacteria

Very common in our day to day environment.

Becomes a problem when the integrity of skin is broken

Causes abscess, boils, infections, and other problems with piercings.

Depending on location of piercing may cause major problems to adjacent structures.

Allergic Reactions, Rejection and Migration An Allergic Reaction is generally acute, localized, and follows with other problems. Some people are allergic to certain lower quality metals. REJECTION is a process in which the pierced skin slowly dies. MIGRATION is the process where the weight, or position, of the piercing causes it to slowly “Grow out”. Takes weeks to months The jewelry may slowly be pushed to the surface of the skin, and may eventually grow out completely. This process may cause some scarring. Bets plan is to have the jewelry moving outward, you may wish to have the jewelry removed before complete rejection takes place. This will minimize any scarring. Some piercings are more prone to rejection than others. Low quality jewelry, non-implant grade metals, personal metabolism, ill health, bad diet, recurring infection, drug abuse, or inappropriate jewelry sizing are other contributing factors. The most common cause of rejection is untreated infection or irritation; treat problems quickly to avoid scarring and possible loss of your piercing.

An Allergic Reaction is generally acute, localized, and follows with other problems. Some people are allergic to certain lower quality metals.

REJECTION is a process in which the pierced skin slowly dies.

MIGRATION is the process where the weight, or position, of the piercing causes it to slowly “Grow out”.

Takes weeks to months

The jewelry may slowly be pushed to the surface of the skin, and may eventually grow out completely. This process may cause some scarring.

Bets plan is to have the jewelry moving outward, you may wish to have the jewelry removed before complete rejection takes place. This will minimize any scarring.

Some piercings are more prone to rejection than others. Low quality jewelry, non-implant grade metals, personal metabolism, ill health, bad diet, recurring infection, drug abuse, or inappropriate jewelry sizing are other contributing factors.

The most common cause of rejection is untreated infection or irritation; treat problems quickly to avoid scarring and possible loss of your piercing.

Rejection

Non Emergent Treatments to Use Consider instructing the patient to call their professional piercer. No dial soap. The universally safe treatment for all piercings with no serious complications is SALTWATER. It can act as a maintenance treatment until you can see a qualified professional piercer or doctor. It is also an excellent non-irritating backup treatment in case of allergic reaction caused by another treatment. If you do not know the cause of your piercing difficulties, you are advised to eliminate all other treatments, and proceed with only SALTWATER, and seek professional assistance promptly. SALTWATER is made by adding 1/4 to 1/2 a teaspoon of Sea Salt to one cup (250ml) of warm water. Measurements provided are exact, do not use more or less salt. Do not use table salt. The piercing is then soaked in the solution using a cup or other container, or by wetting the piercing using saturated gauze or cotton balls. Keep the piercing soaked in the solution for about 5 minutes, then carefully move the jewelry within the piercing. Dry thoroughly with a clean tissue or paper towel.

Consider instructing the patient to call their professional piercer.

No dial soap.

The universally safe treatment for all piercings with no serious complications is SALTWATER. It can act as a maintenance treatment until you can see a qualified professional piercer or doctor. It is also an excellent non-irritating backup treatment in case of allergic reaction caused by another treatment.

If you do not know the cause of your piercing difficulties, you are advised to eliminate all other treatments, and proceed with only SALTWATER, and seek professional assistance promptly.

SALTWATER is made by adding 1/4 to 1/2 a teaspoon of Sea Salt to one cup (250ml) of warm water. Measurements provided are exact, do not use more or less salt. Do not use table salt.

The piercing is then soaked in the solution using a cup or other container, or by wetting the piercing using saturated gauze or cotton balls. Keep the piercing soaked in the solution for about 5 minutes, then carefully move the jewelry within the piercing. Dry thoroughly with a clean tissue or paper towel.

General Removal Guidelines Remove a piercing emergently when: Airway is compromised Beware of lost pieces Inhibits Pt Care (Back Boards) Consider alternative or creative solutions May get torn or compromised during pt packaging. Poses a hazard to EMS providers (needles) X-rays of area are anticipated and it cant be removed later.(Optional) Defibrillation of chest when chest piercings are in place. Otherwise leave it in when ever possible.

Remove a piercing emergently when:

Airway is compromised

Beware of lost pieces

Inhibits Pt Care (Back Boards)

Consider alternative or creative solutions

May get torn or compromised during pt packaging.

Poses a hazard to EMS providers (needles)

X-rays of area are anticipated and it cant be removed later.(Optional)

Defibrillation of chest when chest piercings are in place.

Otherwise leave it in when ever possible.

General Removal Guidelines Always try to unscrew the ball first. Ring opening pliers are best Approx. $10.00-20.00 Stainless Steel Ring Cutters may rip out piercing Trauma shears may not get a good angle to cut

Always try to unscrew the ball first.

Ring opening pliers are best

Approx. $10.00-20.00

Stainless Steel

Ring Cutters may rip out piercing

Trauma shears may not get a good angle to cut

Using Ring Opening Pliers

Simple and Quick

Don’t lose the Ball!

Other Methods Slower, but allow piercing to stay open. Threading an IV cath over piercing, and then through hole as piercing is removed. Remember, always use sterile tech. when messing with piercings!

Slower, but allow piercing to stay open.

Threading an IV cath over piercing, and then through hole as piercing is removed.

Remember, always use sterile tech. when messing with piercings!

The Ears Most common Improper piercing can cause: Infection Granulation/Scarring

Most common

Improper piercing can cause:

Infection

Granulation/Scarring

Coring and Stretching

Coring and stretching

Around the Eyes Anti-Eyebrow Eyebrow Eye Lid

Eye brow and Bridge Piercings 25% of all Eyebrow piercings will migrate. Infection may migrate into orbit of eye, lachrymal glands, or sinus cavity

25% of all Eyebrow piercings will migrate.

Infection may migrate into orbit of eye, lachrymal glands, or sinus cavity

Nose Piercings Very Common Nostril, Septum, and Bridge are common.

Very Common

Nostril, Septum, and Bridge are common.

Nasal Septum Causes problems with Nasal Airway and Nasal ETT Placement when in place. Repeated Peircings may develop scar tissue, posing minor placement problems May amplify blunt trauma forces May inhibit training of blood, causing airway issues Usually is a small diameter stylus between larger parts or is a Ring. Removal:

Causes problems with Nasal Airway and Nasal ETT Placement when in place.

Repeated Peircings may develop scar tissue, posing minor placement problems

May amplify blunt trauma forces

May inhibit training of blood, causing airway issues

Usually is a small diameter stylus between larger parts or is a Ring.

Removal:

Naval Very Common Subject to rejection from rubbing, friction and irritation. 5-10% of all naval piercings will migrate. Increase in girth (pregnancy) may cause problems.

Very Common

Subject to rejection from rubbing, friction and irritation.

5-10% of all naval piercings will migrate.

Increase in girth (pregnancy) may cause problems.

Corset Piercings

Corsets

Oral General Info Relatively High Risk of Infection Airway Issues from: Abscess Bleeding and Soft tissue trauma Aspiration during removal Trauma from: Focusing blunt forces Erosion of tissues Dental damage

Relatively High Risk of Infection

Airway Issues from:

Abscess

Bleeding and Soft tissue trauma

Aspiration during removal

Trauma from:

Focusing blunt forces

Erosion of tissues

Dental damage

Dental Erosion

Uvula Poses complications for airway management Laryngoscope may tear ring Removal may result in Foreign Body Aspiration

Poses complications for airway management

Laryngoscope may tear ring

Removal may result in Foreign Body Aspiration

Deep Oral High Risk piercing

High Risk piercing

Tongue Very Common Heals well May form white callous around piercing

Very Common

Heals well

May form white callous around piercing

Clavicle Poses complications for central line placement and Defib.

Poses complications for central line placement and Defib.

Nipple Rings Very common Should be removed if possible prior to cardioversion If cant be removed, tape in place (anecdotal advice, LOE 8)

Very common

Should be removed if possible prior to cardioversion

If cant be removed, tape in place (anecdotal advice, LOE 8)

Nipple Shields

Male Genitalia Piercings

Male Genitalia Piercings Anecdotal reports of Urethral shredding in blunt trauma. High risk of infection.

Anecdotal reports of Urethral shredding in blunt trauma.

High risk of infection.

Piercing Mishap (be careful when you pull of the clothes)

Female Genitalia Piercings Types: Hood Clitoral Labia May cause problems during childbirth. Obstruction of birth canal Tearing of soft tissue There are flexible items that reduce this chance Should be removed during active labor. May be replaced afterward by pt. Should be removed during Foley Catheter Placement.

Types:

Hood

Clitoral

Labia

May cause problems during childbirth.

Obstruction of birth canal

Tearing of soft tissue

There are flexible items that reduce this chance

Should be removed during active labor.

May be replaced afterward by pt.

Should be removed during Foley Catheter Placement.

Chastity Piercings Chastity devices and chastity piercing s are intended to limit or eliminate sexual fulfillment and access to genitals by both the wearer and anyone other than the person who holds the keys to unlocking the device. For men, this usually includes some device that makes erection impossible or painful. For women, it usually means some device that makes penetration impossible These devices are often worn both in and out of sexual situations The design of the device may cause tearing in trauma.

Chastity devices and chastity piercing s are intended to limit or eliminate sexual fulfillment and access to genitals by both the wearer and anyone other than the person who holds the keys to unlocking the device.

For men, this usually includes some device that makes erection impossible or painful.

For women, it usually means some device that makes penetration impossible

These devices are often worn both in and out of sexual situations

The design of the device may cause tearing in trauma.

“The Shield”

Would this be a problem in childbirth?

Male Chastity Piercings

Heavy Metal?

Tattoos

Tattoos Ancient Art More widely accepted than piercings Also done in less than sterile environments, especially by minors and prisoners Same risks of infections apply HIV HEP B/C Ink problems as well.

Ancient Art

More widely accepted than piercings

Also done in less than sterile environments, especially by minors and prisoners

Same risks of infections apply

HIV

HEP B/C

Ink problems as well.

Tattoo Infection and irritation Some redness is normal, it’s a dermal abrasion! Heat, red streaks, and puss are not normal, especially after 24-48 hours. Pain after 6 hours is not normal. Some very mild tenderness is OK.

Some redness is normal, it’s a dermal abrasion!

Heat, red streaks, and puss are not normal, especially after 24-48 hours.

Pain after 6 hours is not normal. Some very mild tenderness is OK.

Inks Technically falls under FDA as a cosmetic, However not currently regulated at federal level. (May change in next few years) The actual inks may be: Surface Cosmetics, not approved for injection Industrial grade printers ink Occasionally an allergic reaction may occur to the ink (rare)

Technically falls under FDA as a cosmetic, However not currently regulated at federal level. (May change in next few years)

The actual inks may be:

Surface Cosmetics, not approved for injection

Industrial grade printers ink

Occasionally an allergic reaction may occur to the ink (rare)

Branding and Scarring Branding and Scarring

Branding and Scarring Branding Tribal/Primitive Fire strike Modern Cautery Gun Scarring Skin Removal Tattoo Gun Ink Rubbing

Branding

Tribal/Primitive

Fire strike

Modern

Cautery Gun

Scarring

Skin Removal

Tattoo Gun

Ink Rubbing

Fire Strike

Other Body Modifications

Ear Shaping Involves using an incision and sutures to reform the ear.

Involves using an incision and sutures to reform the ear.

Implants (not THOSE type) Usually teflon domes or ½ domes Low incident of rejection Risk of infection depends on piercers adherence to sterile technique

Usually teflon domes or ½ domes

Low incident of rejection

Risk of infection depends on piercers adherence to sterile technique

Subdermal Implants

Transdermal Implants

Suturing

Dental Sharpening Prone to chipping May become airway problems if broken

Prone to chipping

May become airway problems if broken

Tongue Splitting

Other Extreme Mods Out there: Amputation of body parts Penis Modification Subincision Amputation Saline Injections Suspensions Corsetry

Amputation of body parts

Penis Modification

Subincision

Amputation

Saline Injections

Suspensions

Corsetry

Questions? Special Thanks to Nic , Professional Piercer at “Nobodies Hero” at Fairview/Liberty Modified Minds Body Piercing Inside “Nobodies Hero Tattoos” 1505 N. Liberty Boise Idaho 83702 208-429-8850

Special Thanks to Nic , Professional Piercer at “Nobodies Hero” at Fairview/Liberty

Modified Minds Body Piercing

Inside “Nobodies Hero Tattoos”

1505 N. Liberty

Boise Idaho 83702

208-429-8850

More info? www.safepiercing.com www.bmezine.com Contact me at: [email_address]

www.safepiercing.com

www.bmezine.com

Contact me at:

[email_address]

The End The pierced and mod-ed are people too! A little tolerance goes a long way. Don’t remove a piercing unless absolutely necessary. You may make things worse. Piercings and implants change the way the body absorbs trauma. With peircings, there is more than meets the eye (you may be seeing only the tip). Tattoos and brandings are kewl!

The pierced and mod-ed are people too!

A little tolerance goes a long way.

Don’t remove a piercing unless absolutely necessary. You may make things worse.

Piercings and implants change the way the body absorbs trauma.

With peircings, there is more than meets the eye (you may be seeing only the tip).

Tattoos and brandings are kewl!

Have a nice day