Body Modification and You:

Rescue Me conference, 2006

Revision InformationRevision Information

Last revised 10-20-06Last revised 10-20-06For more information contact:For more information contact:

Steve ColeSteve Colecolemedic@hotmail.comcolemedic@hotmail.com

WARNINGWARNING

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

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

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

Dealing with piercings can be a Dealing with piercings can be a pain in our buttpain in our butt

ObjectivesObjectives

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

Identify basic types of Body ModificationIdentify basic types of Body Modification Identify common medical problems with Identify common medical problems with

body modificationbody modificationSuccessfully remove piercings that Successfully remove piercings that

interfere with pt care.interfere with pt care.

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

Brief introduction to Body Brief introduction to Body Modification and its CultureModification and its Culture

ReasonsReasons AestheticAesthetic Social AcceptanceSocial Acceptance

Rites of passageRites of passage Social markingsSocial markings

IdentificationIdentification RebellionRebellion Sexual EnhancementSexual Enhancement Religious ReasonsReligious Reasons OthersOthers

The Romans used their The Romans used their nipple rings to attach nipple rings to attach cloaks to.cloaks to.

Certain primitive tribes Certain primitive tribes used piercings to mimic used piercings to mimic their prey. their prey.

Basic TypesBasic Types

TattoosTattoos Scarring and BrandingScarring and Branding PiercingPiercing

TemporaryTemporary SuperficialSuperficial PocketingPocketing DeepDeep

ImplantsImplants Incisions, amputations Incisions, amputations

and other modificationsand other modifications

Mental Hold IssuesMental Hold Issues There have been cases of There have been cases of

patients being referred to patients being referred to mental health agencies for self mental health agencies for self mutilationmutilation

Mainly for scarring, branding, Mainly for scarring, branding, and temporary piercing.and temporary piercing.

The difference between self The difference between self mutilation and body mutilation and body modification is modification is INTENTINTENT..

Other factors:Other factors: Age of consentAge of consent Desired outcome (changing Desired outcome (changing

sex, etc vs. body adornment)sex, etc vs. body adornment)

Who can do this?Who can do this? Home Piercings are Home Piercings are

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

LegalityLegality IdahoIdaho ElsewhereElsewhere

CertificationsCertifications Associations of Associations of

Professional Piercers Professional Piercers www.safepiercing.comwww.safepiercing.com

The Patients ViewThe Patients View

Fear of:Fear of: Ridicule by Medical Ridicule by Medical

providersproviders Unnecessary removalUnnecessary removal

Be prepared to justify your Be prepared to justify your desire to remove any desire to remove any jewelry jewelry

Fear of piercings healing Fear of piercings healing closed.closed.

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

The Piercers ViewThe Piercers View

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

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

The Cutter and the UndergroundThe Cutter and the Underground

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

A cutter is an A cutter is an undergroundunderground surgical practitioner. surgical practitioner. When contacted through the correct channels are willing to When contacted through the correct channels are willing to

perform procedures such as perform procedures such as subincisionsubincision and and tongue splittingtongue splitting (or (or more radical procedures) that the formal medical community is more radical procedures) that the formal medical community is unable or unwilling to perform. unable or unwilling to perform.

Some have medical training, but some do not. Some have medical training, but some do not. Cutters almost always work illegally or at least in a gray Cutters almost always work illegally or at least in a gray

area, so contacting a cutter is usually done through a area, so contacting a cutter is usually done through a series of anonymous and pseudo-anonymous contacts series of anonymous and pseudo-anonymous contacts (often former clients who act as a screening service). (often former clients who act as a screening service).

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

Piercings

“…“…Vanity looks Vanity looks best when it's best when it's

wrapped in wrapped in steel.”steel.”

-Rev. Vain Jayne-Rev. Vain JayneChurch of Body ModificationChurch of Body Modification

www.vainjaynewww.vainjayne .com .com

Standard/SurfaceStandard/Surface All shapes and sizesAll shapes and sizes Almost any location.Almost any location. Also includesAlso includes

CoringCoring StretchingStretching PocketingPocketing StaplingStapling Suspension piercingsSuspension piercings

Flexible surgical plastic Flexible surgical plastic and solid barsand solid bars

Temporary and Temporary and permanentpermanent

DeepDeep Often go under or Often go under or

through tissues and through tissues and structures.structures.

Usually flexible Usually flexible connectionconnection Surgical TeflonSurgical Teflon

TemporaryTemporary

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

scenes.scenes.

Temporary Piercings

Temporary Piercings-Other Temporary Piercings-Other ExamplesExamples

Stapling and Stapling and PocketingPocketing

Staples:Staples: Easy to removeEasy to remove Not connectedNot connected

Pocketing:Pocketing: Difficult to remove in Difficult to remove in

fieldfield Look for the scarLook for the scar

Surface Weaving, not pocketingSurface Weaving, not pocketing

Another Example Another Example (Wolverine)(Wolverine)

What is normal after a piercing?What is normal after a piercing?

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

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

Understanding Bad PiercingsUnderstanding Bad Piercings

Piercing GunsPiercing Guns Hep B/C, etcHep B/C, etc

Lack of sterile tech. and Lack of sterile tech. and equipmentequipment

InfectionsInfections Rejection and MigrationRejection and Migration Scar tissue/GranulationScar tissue/Granulation Bad LocationsBad Locations

High Risk PiercingsHigh Risk Piercings

Cardiac Valve Cardiac Valve DiseaseDisease

DiabetesDiabetes Immune suppressedImmune suppressed Environmental or Environmental or

professional contra-professional contra-indicationsindications

PregnancyPregnancy Depending on locationDepending on location

Infections and Infections and AbscessesAbscesses

InfectionsInfections

Some redness 1-3 Some redness 1-3 days post piercing days post piercing is normalis normal

Drainage, pus, and Drainage, pus, and red streaks are not.red streaks are not.

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

StaphStaph

staphylococcus aureusstaphylococcus aureus bacteria bacteria Very common in our day to day environment.Very common in our day to day environment. Becomes a problem when the integrity of skin is Becomes a problem when the integrity of skin is

brokenbroken Causes abscess, boils, infections, and other Causes abscess, boils, infections, and other

problems with piercings. problems with piercings. Depending on location of piercing may cause Depending on location of piercing may cause

major problems to adjacent structures.major problems to adjacent structures.

Allergic Reactions, Rejection and Allergic Reactions, Rejection and MigrationMigration

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

REJECTION is a process in which the pierced skin slowly dies.REJECTION is a process in which the pierced skin slowly dies. MIGRATION is the process where the weight, or position, of the piercing MIGRATION is the process where the weight, or position, of the piercing

causes it to slowly “Grow out”.causes it to slowly “Grow out”. Takes weeks to monthsTakes weeks to months The jewelry may slowly be pushed to the surface of the skin, and may The jewelry may slowly be pushed to the surface of the skin, and may

eventually grow out completely. This process may cause some scarring. 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 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 jewelry removed before complete rejection takes place. This will minimize any scarring. any scarring.

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

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

RejectionRejection

Non Emergent Treatments to UseNon Emergent Treatments to Use

Consider instructing the patient to call their Consider instructing the patient to call their professionalprofessional piercer. piercer. No dial soap.No dial soap. The universally safe treatment for all piercings with no serious complications 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 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 qualified professional piercer or doctor. It is also an excellent non-irritating backup treatment in case of allergic reaction caused by another treatment. 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 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 eliminate all other treatments, and proceed with only SALTWATER, and seek professional assistance promptly.seek professional assistance promptly.

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

The piercing is then soaked in the solution using a cup or other container, or 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 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 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 jewelry within the piercing. Dry thoroughly with a clean tissue or paper towel. towel.

General Removal GuidelinesGeneral Removal Guidelines Remove a piercing emergently when:Remove a piercing emergently when:

Airway is compromisedAirway is compromised Beware of lost piecesBeware of lost pieces

Inhibits Pt Care (Back Boards)Inhibits Pt Care (Back Boards) Consider alternative or creative solutionsConsider alternative or creative solutions

May get torn or compromised during pt packaging.May get torn or compromised during pt packaging. Poses a hazard to EMS providers (needles)Poses a hazard to EMS providers (needles) X-rays of area are anticipated and it cant be removed X-rays of area are anticipated and it cant be removed

later.(Optional)later.(Optional) Defibrillation of chest when chest piercings are in Defibrillation of chest when chest piercings are in

place. place. Otherwise leave it in when ever possible. Otherwise leave it in when ever possible.

General Removal GuidelinesGeneral Removal Guidelines

Always try to unscrew Always try to unscrew the ball first.the ball first.

Ring opening pliers are Ring opening pliers are bestbest Approx. $10.00-20.00 Approx. $10.00-20.00 Stainless SteelStainless Steel

Ring Cutters may rip out Ring Cutters may rip out piercingpiercing

Trauma shears may not Trauma shears may not get a good angle to cutget a good angle to cut

Using Ring Opening PliersUsing Ring Opening Pliers

Simple and QuickSimple and Quick

Don’t lose the Ball!Don’t lose the Ball!

Other MethodsOther Methods Slower, but allow piercing to stay open.Slower, but allow piercing to stay open. Threading an IV cath over piercing, and then Threading an IV cath over piercing, and then

through hole as piercing is removed.through hole as piercing is removed. Remember, always use sterile tech. when Remember, always use sterile tech. when

messing with piercings!messing with piercings!

The EarsThe Ears

Most commonMost common Improper piercing can Improper piercing can

cause:cause: InfectionInfection Granulation/ScarringGranulation/Scarring

Coring and StretchingCoring and Stretching

Coring and stretching Coring and stretching

Around the EyesAround the Eyes

Anti-Eyebrow

Eyebrow

Eye Lid

Eye brow and Bridge PiercingsEye brow and Bridge Piercings

25% of all Eyebrow 25% of all Eyebrow piercings will migrate. piercings will migrate.

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

Nose PiercingsNose Piercings

Very CommonVery Common Nostril, Septum, and Nostril, Septum, and

Bridge are common.Bridge are common.

Nasal SeptumNasal Septum Causes problems with Nasal Causes problems with Nasal

Airway and Nasal ETT Airway and Nasal ETT Placement when in place.Placement when in place.

Repeated Peircings may Repeated Peircings may develop scar tissue, posing develop scar tissue, posing minor placement problemsminor placement problems

May amplify blunt trauma May amplify blunt trauma forcesforces

May inhibit training of blood, May inhibit training of blood, causing airway issuescausing airway issues

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

Removal:Removal:

NavalNaval

Very CommonVery Common Subject to rejection Subject to rejection

from rubbing, friction from rubbing, friction and irritation.and irritation.

5-10% of all naval 5-10% of all naval piercings will migrate.piercings will migrate.

Increase in girth Increase in girth (pregnancy) may (pregnancy) may cause problems. cause problems.

Corset PiercingsCorset Piercings

CorsetsCorsets

Oral General InfoOral General Info

Relatively High Risk of InfectionRelatively High Risk of Infection Airway Issues from:Airway Issues from:

AbscessAbscess Bleeding and Soft tissue traumaBleeding and Soft tissue trauma Aspiration during removalAspiration during removal

Trauma from:Trauma from: Focusing blunt forcesFocusing blunt forces Erosion of tissuesErosion of tissues Dental damageDental damage

Dental ErosionDental Erosion

UvulaUvula

Poses complications Poses complications for airway for airway managementmanagement

Laryngoscope may Laryngoscope may tear ringtear ring

Removal may result Removal may result in Foreign Body in Foreign Body AspirationAspiration

Deep OralDeep Oral High Risk piercingHigh Risk piercing

TongueTongue

Very CommonVery Common Heals wellHeals well May form white callous around piercingMay form white callous around piercing

ClavicleClavicle

Poses complications Poses complications for central line for central line placement and Defib.placement and Defib.

Nipple RingsNipple Rings

Very commonVery common Should be removed if Should be removed if

possible prior to possible prior to cardioversioncardioversion

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

Nipple ShieldsNipple Shields

Male Genitalia PiercingsMale Genitalia Piercings

Male Genitalia PiercingsMale Genitalia Piercings

Anecdotal reports of Anecdotal reports of Urethral shredding in Urethral shredding in blunt trauma.blunt trauma.

High risk of infection.High risk of infection.

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

Female Genitalia PiercingsFemale Genitalia Piercings Types:Types:

HoodHood ClitoralClitoral LabiaLabia

May cause problems during May cause problems during childbirth.childbirth. Obstruction of birth canalObstruction of birth canal Tearing of soft tissueTearing of soft tissue There are flexible items that There are flexible items that

reduce this chancereduce this chance Should be removed during Should be removed during

active labor.active labor. May be replaced afterward by May be replaced afterward by

pt. pt. Should be removed during Should be removed during

Foley Catheter Placement.Foley Catheter Placement.

Chastity PiercingsChastity Piercings Chastity devices and Chastity devices and chastity piercingchastity piercings are intended to s are intended to

limit or eliminate sexual fulfillment and access to genitals limit or eliminate sexual fulfillment and access to genitals by both the wearer and anyone other than the person by both the wearer and anyone other than the person who holds the keys to unlocking the device. who holds the keys to unlocking the device.

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

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

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

The design of the device may cause tearing in trauma. The design of the device may cause tearing in trauma.

““The Shield”The Shield”

Would this be a problem in Would this be a problem in childbirth?childbirth?

Male Chastity PiercingsMale Chastity Piercings

Heavy Metal?Heavy Metal?

Tattoos

TattoosTattoos Ancient ArtAncient Art More widely accepted More widely accepted

than piercingsthan piercings Also done in less than Also done in less than

sterile environments, sterile environments, especially by minors and especially by minors and prisonersprisoners

Same risks of infections Same risks of infections applyapply HIVHIV HEP B/CHEP B/C

Ink problems as well.Ink problems as well.

Tattoo Infection and irritationTattoo Infection and irritation

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

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

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

InksInks

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

The actual inks may be:The actual inks may be:Surface Cosmetics, not approved for injectionSurface Cosmetics, not approved for injection Industrial grade printers inkIndustrial grade printers ink

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

Branding and ScarringBranding and ScarringBranding and Scarring

Branding and ScarringBranding and Scarring

BrandingBranding Tribal/PrimitiveTribal/Primitive

Fire strikeFire strike

ModernModern Cautery GunCautery Gun

ScarringScarring Skin RemovalSkin Removal Tattoo GunTattoo Gun Ink RubbingInk Rubbing

Fire StrikeFire Strike

Other Body Modifications

Ear ShapingEar Shaping

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

Implants (not THOSE type)Implants (not THOSE type)

Usually teflon domes Usually teflon domes or ½ domesor ½ domes

Low incident of Low incident of rejectionrejection

Risk of infection Risk of infection depends on piercers depends on piercers adherence to sterile adherence to sterile technique technique

Subdermal ImplantsSubdermal Implants

Transdermal ImplantsTransdermal Implants

SuturingSuturing

Dental Dental SharpeningSharpening

Prone to Prone to chippingchipping

May become May become airway airway problems if problems if brokenbroken

Tongue SplittingTongue Splitting

Other Extreme Mods Out there:Other Extreme Mods Out there:

Amputation of body partsAmputation of body partsPenis ModificationPenis Modification

SubincisionSubincisionAmputationAmputation

Saline InjectionsSaline InjectionsSuspensionsSuspensionsCorsetryCorsetry

Questions?Questions?

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

Modified Minds Body PiercingModified Minds Body Piercing Inside “Nobodies Hero Tattoos”Inside “Nobodies Hero Tattoos”

1505 N. Liberty1505 N. LibertyBoise Idaho 83702Boise Idaho 83702208-429-8850208-429-8850

More info?More info?

www.safepiercing.comwww.safepiercing.comwww.bmezine.comwww.bmezine.com

Contact me at:Contact me at:colemedic@hotmail.comcolemedic@hotmail.com

The EndThe End

The pierced and mod-ed are people too!The pierced and mod-ed are people too!A little tolerance goes a long way.A little tolerance goes a long way.Don’t remove a piercing unless absolutely Don’t remove a piercing unless absolutely

necessary. You may make things worse.necessary. You may make things worse.Piercings and implants change the way Piercings and implants change the way

the body absorbs trauma. the body absorbs trauma. With peircings, there is more than meets With peircings, there is more than meets

the eye (you may be seeing only the tip).the eye (you may be seeing only the tip).Tattoos and brandings are kewl!Tattoos and brandings are kewl!

Have a nice dayHave a nice day