Friday, July 18, 2008

It's Friday, and Round One of the Mom visit is drawing to a close. Whew.

Meanwhile, here's another podcast. This one is less silly and possibly a bit more controversial than usual. Monk and I read a letter and discuss the idea of using BDSM as a tool in chronic pain management. Hope you find it thought-provoking.

Thursday, July 17, 2008

Advanced BDSM: Branding
Dear MM,

(Edited: nice compliments.) So ... I started seeing this girl awhile ago. She works at a bakery and continually gets these small (quarter sized) burns from mishandling equipment at work. Anyway, we're both fairly into BDSM and after playing a lot together, I asked her if the burns were, well, purposefully inflicted -- she said they were.

Anyway, my question is this: is there anything you know of that can cause localized intense sensation in the general ballbark of having a third-degree burn, without, you know, the medical drawbacks of having third-degree burns?

I have to admit, the burns are small and she's treated everything properly and hasn't had any infections/serious complications so far, but I worry.

This is sort of sweet to me. I think is how a good top/lover should be: wanting to give their partner what they like, but wanting them to be safe, too.

That said, burning/branding is advanced BDSM, and if you do it wrong, the consequences are going to be severe. That doesn't mean you shouldn't do it. I've done it, and I've had it done to me. (My opinion on having it done to me: Ow! But I like doing it, go figure.)

But understand: what you're about to read is NOT a branding lesson. It’s my opinion that you cannot learn branding just by reading about it. You need to be carefully taught, in person, by someone who's done it and has a clear understanding of how it works. Reading this blog post does NOT mean you’re now all qualified to burn/brand someone.

However, I did send this email to my pervy-medical-advice friends for their take, and here’s what they said…

(Based on some edited-out information, I have reason to believe that the writer of this letter is a detail-oriented, geeky type of guy. So while I’d normally edit this down and just give you the quick and dirty, this time I elected to let the medical guys have their full say. Get comfortable.)

Dr Moreau: The questioner's phrasing raises some questions. If we're talking about things that are not burns but which cause a burning sensation, there's been plenty written about chemicals like Tiger Balm, and other things that sting. But it sounds like he's asking about something that actually is a burn of some kind.

There's sunburn, from the usual source or artificial ones, which can be localized -- e.g., by cutouts in clothing. This is typically first degree, though of course second-degree sunburns (i.e., with blistering) are not rare. There's a known association with elevated risk of skin cancer, as everyone probably knows by now. If the interest is in deeper burns, there's branding and the like, in which I have fairly minimal personal experience. I am not conversant enough in branding technique to identify the usual intent, but I imagine that it would be a second-degree or borderline third-degree burn, extremely localized.

The problem is in controlling the amount of thermal energy delivered to the tissue, the main factors of which would probably be the temperature of the appliance, the rate of heat transfer, and the duration and depth of application. I know of some cases in which much more extensive scarring ensued than was expected. I think experience is key here -- the risk is significant, and I think if one undertakes this, one should proceed very slowly and incrementally.

The burns he describes sound like first-degree or very mild second-degree, nowhere near "the general ballpark of having a third-degree burn." A third-degree burn involves destruction of deeper tissues, and may not have any sensation at all, if the nerves are burned, though the less-burned surrounding area may be terribly painful. And the months or years of recovery and potential infections are unlikely to seem very erotic.

I cannot readily imagine third-degree burns of any extent beyond smallish brands and the like being the intent of a scene, unless truly informed consent is absent (i.e., all parties are woefully ignorant of what they're getting themselves into), or, by another metric, unless safety/sanity is right out the window...due to the control problem mentioned above. And I tend to be pretty damn broad about my interpretation of consent and safety.

Dr Strangelove: I've never used electrocautery tools before, they're more of a surgeon thing. But there are also things called LEEPs (loop electrode surgery procedures) that use an electrically charged wire to cut through tissue but I think they're actually supposed to be low pain compared to scalpels. A soldering iron would probably be a good reusable, easily heatable item, but those get damn hot so good control would be very important to avoid going too deep. You can even get replacement tips for the soldering irons so you could use a new tip thus lowering your cross contamination risk...not that I'd be too worried about bacteria or viruses since...

Thankfully most anything that you use to burn someone is going to be pretty clean by virtue of it being very hot. But I would still recommend a good quality stainless steel if you are heating a separate implement in a heat source and then burning with the implement. A disposable scalpel heated and then applied to the skin would be a good option, I think (apply the broad side or the blunt edge). Also make sure the person is up to date on their tetanus booster.

Avoid applying creams or gels or oil based products to burns, a good sterile dressing loosely applied to the area is generally sufficient. Do not remove any blisters that may form from the initial burn. Fluid within the blister is generally sterile and opening the blister only increases the possibility of infection. Do not burn the full circumference of any limb (i.e. all the way around a leg, arm, finger, penis, etc) and be careful of burns to the neck since swelling caused by a fluid shift in this region could cause breathing problems. Similarly burns to the hands, feet and face are considered 'high risk' burns. 2-3 inches in diameter is considered a serious burn and we would recommend having that looked at by a professional. If a burned area begins to swell around the full circumference of the region (be it around a limb, around the chest, etc) see a medical professional. Likewise, if swelling appears to be increasing and sensation is being
altered nearby (i.e. your arm is swelling and your fingers feel funny) see a medical professional.

Quick breakdown of assessing if you've burned too much:
1st degree: Pain, redness, some swelling --> OK. Run under cold water (or don't...) and let it heal. Do not put ice or other creams on the injury site.

2nd degree: Pain, redness, blistering or broken skin ---> Run under cold water, cover with clean cotton dressing or other bandage. No creams, ice, etc. Do not pop blisters. May scar or result in altered sensation.

3rd degree: Likely no pain in the general region, split or absent skin, charring, dry to the touch. --> Not OK. Scarring is certain, see a medical professional because complications and/or infections from this type of burn are common. Yes, it might heal, but it's a high risk incident and I wouldn't bet my license on it. These burns result in nerve damage, severe scarring, dehydration and infection.

If you're asking about the dangers of repeated burning...nothing magical there I think, just scarring, infection, etc. Pretty much the same risks as you'd get from cutting although your risk of scarring is much greater. I would also remind your guy that it's not the pain of a 3rd degree burn that she's after, a 3rd degree burn is painless. Once you pass the 2nd degree stage you'll have killed the nerves. So there's no point in burning after a certain point unless you really want to have serious scarring and infection risk. Generally speaking, 1st degree burns that blister (might actually be a superficial 2nd at that juncture) are probably the most painful.

Tuesday, July 15, 2008

Scheduling note to my friends: I'm doing family duty today. But I am available to slip away for an hour here and there Wednesday and Thursday, and I'm back to being available Friday.

To amuse you: just for fun, I went back through the archives to see what I wrote about around this date in previous years. So enjoy the blasts from the past.
July 2004: Strange Emails
July 2005: Silly Phone calls
July 2006: Drugs and Music
July 2007: More Phone Oddness

Monday, July 14, 2008

An odd occurrence recently...

Someone I have not met before contacted me about a session. I am not meeting very many new people these days - the gentlemen I already know keep me pretty busy. But if you have a reference from another woman, someone local with a good reputation, then I'm open to talking to you. (More about how sex-worker references work.)

This man said he had a reference. So I sent an email to the lady he named. Now, usually this sort of information-exchange is pretty rote. For example:
Hello... A gentleman named Bob contacted me and said he knows you. His email is, he says he saw you about two months ago, and you'll recall him because you two both love lawn-bowling and you talked about it. Thanks!
Hi... Oh yeah, I remember Bob. Yes, he's a very nice guy, tell him I said hi.
Like that. It's rare to get a negative response, partly because most clients are decent guys, and also they are not dumb enough to give you the name of a woman who they know had an issue with them.

And it's also rare for women to discuss anything intimate about a client - that's not what this is about. The purpose is to ascertain a very basic level of safety. And Seattle sex workers are usually very good about answering these kinds of emails, even with women they don't know personally.

It's also considered nice, although not absolutely necessary, for the client to drop a note to the woman he's already met, telling her that he's using her as a reference to another lady.

Thus, I was surprised to get an email back saying, "No, I've never met this guy. We're exchanged emails, but that's all. I had no idea that he was giving me as a reference to anyone."

Huh. How strange. I'm not sure if the man in question just doesn't understand how a reference works? Or maybe he thought I wouldn't check? Either way, it's just odd.