Body Modification and You

Slide 1: Body Modification and You: Rescue Me conference, 2006

Slide 2: Revision Information  Last revised 10-20-06  For more information contact:  Steve Cole  colemedic@hotmail.com

Slide 4: 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.

Slide 5: Dealing with piercings can be a pain in our butt

Slide 6: 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.

Slide 7: I ne ve r wa nte d to b e diffe re nt , I jus t wa nte d to b e m e …

Slide 8: 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.

Slide 9: Basic Types  Tattoos  Scarring and Branding  Piercing  Temporary  Superficial  Pocketing  Deep  Implants  Incisions, amputations and other modifications

Slide 10: 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)

Slide 11: 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

Slide 12: 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.

Slide 13: 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.

Slide 14: 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?

Slide 15: Piercings

Slide 16: “… nity looks Va be s t wh e n it's wra ppe d in s te e l.” -Rev. Vain Jayne Church of Body Modification www.vainjayne .com

Slide 17: 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

Slide 18: Deep  Often go under or through tissues and structures.  Usually flexible connection  Surgical Teflon

Slide 19: Temporary 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.

Slide 20: Temporary Piercings-Other Examples

Slide 21: Stapling and Pocketing  Staples:  Easy to remove  Not connected  Pocketing:  Difficult to remove in field  Look for the scar

Slide 25: Surface Weaving, not pocketing

Slide 26: Another Example (Wolverine)

Slide 27: 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.

Slide 28: Understanding Bad Piercings  Piercing Guns  Hep B/C, etc  Lack of sterile tech. and equipment  Infections  Rejection and Migration  Scar tissue/Granulation  Bad Locations

Slide 29: High Risk Piercings  Cardiac Valve Disease  Diabetes  Immune suppressed  Environmental or professional contra- indications  Pregnancy  Depending on location

Slide 30: Infections and Abscesses

Slide 31: 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.

Slide 32: 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.

Slide 33: 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.

Slide 34: Rejection

Slide 35: 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.

Slide 36: 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.

Slide 37: 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

Slide 38: Using Ring Opening Pliers

Slide 39: Simple and Quick

Slide 40: Don’t lose the Ball!

Slide 41: 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!

Slide 42: The Ears  Most common  Improper piercing can cause:  Infection  Granulation/Scarring

Slide 43: Coring and Stretching

Slide 44: Coring and stretching

Slide 45: Around the Eyes Eyebrow Eye Lid Anti-Eyebrow

Slide 46: Eye brow and Bridge Piercings  25% of all Eyebrow piercings will migrate.  Infection may migrate into orbit of eye, lachrymal glands, or sinus cavity

Slide 47: Nose Piercings  Very Common  Nostril, Septum, and Bridge are common.

Slide 48: 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:

Slide 49: 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.

Slide 50: Corset Piercings

Slide 51: Corsets

Slide 52: 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

Slide 53: Dental Erosion

Slide 54: Uvula  Poses complications for airway management  Laryngoscope may tear ring  Removal may result in Foreign Body Aspiration

Slide 55: Deep Oral  High Risk piercing

Slide 56: Tongue  Very Common  Heals well  May form white callous around piercing

Slide 57: Clavicle  Poses complications for central line placement and Defib.

Slide 59: Nipple Rings  Very common  Should be removed if possible prior to cardioversion  If cant be removed, tape in place (anecdotal advice, LOE 8)

Slide 60: Nipple Shields

Slide 61: Male Genitalia Piercings

Slide 62: Male Genitalia Piercings  Anecdotal reports of Urethral shredding in blunt trauma.  High risk of infection.

Slide 63: Piercing Mishap (be careful when you pull of the clothes)

Slide 64: 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.

Slide 66: Chastity Piercings  Chastity devices and chastity piercings 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.

Slide 67: “The Shield”

Slide 68: Would this be a problem in childbirth?

Slide 69: Male Chastity Piercings

Slide 70: Heavy Metal?

Slide 72: Tattoos

Slide 73: 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.

Slide 74: 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.

Slide 75: 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)

Slide 76: Branding andScarring Branding and Scarring

Slide 77: Branding and Scarring  Branding  Tribal/Primitive  Fire strike  Modern  Cautery Gun  Scarring  Skin Removal  Tattoo Gun  Ink Rubbing 

Slide 78: Fire Strike

Slide 80: Other Body Modifications

Slide 81: Ear Shaping  Involves using an incision and sutures to reform the ear.

Slide 82: Implants (not THOSE type)  Usually teflon domes or ½ domes  Low incident of rejection  Risk of infection depends on piercers adherence to sterile technique

Slide 83: Subdermal Implants

Slide 84: Transdermal Implants

Slide 85: Suturing

Slide 86: Dental Sharpening  Prone to chipping  May become airway problems if broken

Slide 87: Tongue Splitting

Slide 88: Other Extreme Mods Out there:  Amputation of body parts  Penis Modification  Subincision  Amputation  Saline Injections  Suspensions  Corsetry

Slide 89: 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

Slide 90: More info?  www.safepiercing.com  www.bmezine.com  Contact me at:  colemedic@hotmail.com

Slide 91: 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!

Slide 92: Have a nice day