Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
You fall off your bike, bang your shin on the coffee table
(that you swore you would move months ago) or run into a wall and wake up with a
wallop of a bruise. What is a bruise, and
what can you do about it? A bruise (medically referred to as a contusion) is caused
when tiny blood vessels are damaged or broken as the result of a blow to the
skin (be it bumping against something or hitting yourself with a hammer). The
raised area of a bump or bruise results from blood leaking from these injured
blood vessels into the tissues as well as from the body's response to the
injury. A purplish,
flat bruise that occurs when blood leaks out into the top layers
of skin is referred to as an ecchymosis.
Why do bruises occur more frequently in some
people than in others?
The injury required to produce a bruise varies with
age. While it may take quite a bit of force to cause a bruise
in a young child, even minor bumps and scrapes may cause extensive
bruising or ecchymosis in an elderly person. Blood vessels become
more fragile as we age, and bruising may even occur without prior
injury in the elderly.
The amount of bruising may also be affected by medications
which interfere with blood clotting (and thus cause more bleeding
into the skin or tissues). These drugs include many prescriptionarthritis medications called nonsteroidal
antiinflammatories
(for example, ibuprofen [Advil, Nuprin] and naproxen [Aleve]) as well as
over-the-counter medications, such as aspirin. Warfarin (Coumadin) is
often prescribed by doctors specifically to prevent clotting in patients who
have had blood clots in their legs or heart. Warfarin can cause particularly
severe bruising, especially if the level of the medication becomes too high. Cortisone medications, such
as prednisone, promote bruising by increasing the fragility of
the tiny blood vessels in the skin. In addition, patients with
inherited clotting problems (such as in hemophilia) or acquired
clotting problems (such as in patients with liver diseases like
cirrhosis), can develop extensive bruising or even life-threatening
bleeding.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Foot pain may be caused by injuries (sprains, strains, bruises, and fractures), diseases (diabetes, Hansen disease, and gout), viruses, fungi, and bacteria (plantar warts and athlete's foot), or even ingrown toenails. Pain and tenderness may be accompanied by joint looseness, swelling, weakness, discoloration, and loss of function. Minor foot pain can usually be treated with rest, ice, compression, and elevation and OTC medications such as acetaminophen and ibuprofen. Severe pain should be treated by a medical professional.
A hematoma is a collection of blood that is outside a blood vessel. There are different areas where hematomas occur including the inside the skull, scalp, ear, septum, bones, finger and toenails, and intra-abdominal. Treatment for hematomas depend on the type and location of the hematoma.
A broken toe is one of the most common fractures among individuals. There are many causes of a broken toe, whether it is the big toe, middle toes, or little toe (pinky). Common symptoms of a broken toe include pain, swelling, stiffness, and bruising. A broken toe can be treated with buddy taping the toe. There are instances where a physician should be consulted for a broken toe.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Cuts, scrapes, and puncture wounds are common, and most people will experience one of these in their lifetime. Evaluating the injury, and thoroughly cleaning the injury is important. Some injuries should be evaluated by a doctor, and a tetanus shot may be necessary. Treatment will depend upon the severity of the injury.
There are two categories to cold weather-related injuries. 1) no freezing of body tissue (trench foot and chilblains), and 2) freezing of body tissues (frostbite). Chilblains in general, will not need medical attention (unless there is infection). Trench foot and frostbite, however, require medical attention. Symptoms of frostbite include pain, burning, numbness, and eventually a complete loss of sensation in the affected body part. The young, elderly, and patients with certain medical conditions (diabetes, hypothyroidism, circulatory problems, and psychiatric illnesses), are more susceptible to cold weather-related injuries. People who abuse alcohol and illicit drug user are also at risk for cold weather-related injuries.
Shaken baby syndrome is a form of child abuse in which violent shaking of an infant causes the brain to move inside the skull, causing bruising of the brain and tearing of blood vessels. The shaking results in bleeding around the brain, bleeding in the eyes, spinal cord and neck injuries, bruises, and rib fractures. Infants who survive may suffer brain damage and blindness.
Compartment syndrome is a condition in which swelling and an increase in pressure within a limited space presses and compresses blood vessels, nerves, or tendons that run through the compartment. There are two types of compartment syndrome, acute compartment syndrome is treated with surgery (fasciotomy) and chronic compartment syndrome, which is treated with rest and modality to the affected limb. Symptoms of compartment syndrome include pain, change in sensation, change in color, paralysis, or numbness in the affected limb.
The most common cause of a black eye is due to an injury to the face or head. Most black eye injuries are minor and heal on their own, however, some may lead to significant injury. In addition to trauma to the face, cosmetic surgery can cause a black eye(s) as a side effect. People should be aware of the situations in which medical care should be sought immediately for a black eye.
Idiopathic means that the cause of the condition isn't known. Thrombocytopenic means there's a lower than normal number of platelets in the blood. Purpura refers to purple bruises caused by bleeding under the skin. Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets.
Yellow fever is an infectious disease transmitted by infected mosquitoes. Side effects are rare with the yellow fever vaccine. Symptoms include fever, chills, back pain, nausea, vomiting, and headache. Treatment is aimed at relieving symptoms.
Bernard-Soulier disease is a rare inherited bleeding disorder caused by a defect in the platelet glycoprotein complex 1b-IX-V. Symptoms and signs include bruising, nosebleeds, gum bleeding, and problems with anything that induces bleeding, such as surgery, ulcers, trauma, and menstruation. Treatment involves avoiding medications that interfere with clot formation, such as naproxen, ibuprofen, and aspirin. People with Bernard-Soulier syndrome should avoid contact sports.
Place the pump, which can be pumped by hand or run on batteries, over the penis.
Pump the air out of the cylinder so that a vacuum is created. The vacuum draws blood into the shaft of the penis and causes it to swell and become erect.
Once the penis is erect, with the help of lubricant, slide the retaining band down onto the lower end of the penis.
Remove the pump after releasing the vacuum.
Intercourse can be attempted with the constriction band in place to help
maintain the erection. The band can be left on safely for up to 30 minutes to
allow for successful intercourse.
Be sure that devices brought without a prescription contains a "quick release" feature, as there have been reports of penile injuries due to devices that did not release its vacuum on-demand or released it too slowly.
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