The phrase came to mean going out with the intention of getting, or causing, hurt, but other than pugilistic parley, how else might one get bruised?
First, we should define what represents a bruise, or ecchymosis in medi-speak; it is an area of discolored skin due to blood leaking out of arteries, veins, or capillaries. In those with fair skin, and depending on how deep the bruise, it may initially appear red and change to yellow, green, black, blue, and purple over a period of time. This changing appearance is due to degradation of hemoglobin, the oxygen-carrying component of blood. In those with darker skin tones, or for deeper injuries, the color palate may be less profound.
Unless you are perfect, and free of imperfections, it is important to know one’s skin, so a regular survey of your body after a shower to look for different discolorations and blemishes makes sense. A new, painless, dark or multicolor area, that might look like a bruise, may be a simple, harmless mole or a nasty melanoma or other form of skin cancer. Other abnormalities that may be confusing, not bruising, include Campbell de Morgan spots, small bundles of red vessels that tend to appear after age 40, spider naevi, similar tangles of small vessels that can look like a spider’s web and indicate liver disease, as well as various assorted harmless lesions. As always, if in doubt, and especially with new marks, consult your doctor. At the very least, take a photograph with a ruler next to the abnormality so one can monitor changes in size over time.
Assuming you can relate the presence of a bruise to a particular incident, and if the pain is not incapacitating, the swelling neither too great nor increasing and range of motion of the relevant body part not impaired, it will probably resolve over 2–3 weeks. If those criteria are not met, there is no harm in being checked for a more serious underlying problem. During the initial post-injury phase, rest, apply ice packs and a bandage for mild compression, and, if possible, elevate the injured limb. Avoid medications that interfere with blood clotting such as aspirin or ibuprofen, so-called non-steroidal anti-inflammatory drugs or NSAIDs.
If the “bruise” is increasing in size with a visible and palpable lump, this may be a developing hematoma or blood collection and might suggest an ongoing underlying process. For instance, with a broken thigh bone, one can bleed two pints or more into the upper leg, compromising circulation and tissues in the limb. Some recommend vitamin creams, eating pineapple, or applying extracts of comfrey, a plant said to have healing effects; this latter has some interesting positive evidence.
If taking prescribed “blood-thinning” or anticoagulant medication, such as Coumadin, prasugrel, apixaban, or clopidogrel, and the bruise seems out of context with the causative injury, report to your doctor promptly as this might indicate your dose needs adjusting. Also, you will have been told when starting such medications that foods rich in vitamin K such as asparagus, cauliflower, and leafy green vegetables should be consumed with caution as they impact the coagulation pathway.
Conversely, taking large doses of NSAIDs, or steroids, or consuming a diet poor in vitamin K and C can lead to bleeding gums, a bruising tendency, and various other symptoms. Patients undergoing treatment with chemotherapy drugs or radiation to address a cancerous disease can develop bleeding problems that might present with spontaneous bruising.
Embarking on an aggressive exercise regime can provoke bruising from repetitive injury, so, before commencing, obtain proper guidance from a certified trainer or your doctor. Additionally, ensure you obtain proper footwear as compromising calisthenics can bring on bruising in the feet, ankles, and knees, which can be very painful.
Females bruise more readily than males and, as we age, the incidence increases. A propensity to bruise can run in families without reaching the criteria of being a “disease,” but various inherited maladies can result in easy bruising, with many declaring themselves in childhood such as hemophilia or Ehlers-Danlos syndrome, but these are rare and would require an FAA decision concerning eligibility to fly. However, Von Willebrand’s disease, where one is missing a factor required for blood to clot, is tricky in that it may not pop up until later in life. However, it is treatable and should not be ignored, lest major blood loss occur.
Any chronic illness such as diabetes, liver disease, a hidden solid organ, or blood cancer can interfere with the process by which blood clots. Furthermore, a condition called immune thrombocytopenia, ITP, where the immune system mistakenly attacks a blood component called platelets such that the most minor trauma causes a large bruise. In Cushing’s syndrome there is too much circulating cortisol and that leads to thinner skin that bruises easily. Any new tendency to develop a shiner should result in seeing your doctor promptly.
As always, remember the aeromedical implications of any change in your medical condition, significant trauma that causes pain, swelling, and disturbed movement should probably lead the prudent pilot to stay out of the cockpit until fully recovered; after all, one would not want to go cruisin’ for a bruisin’ from FAA!
Fly Well!
You can send your questions and comments to Dr. Sackier via email: [email protected] and listen to his weekly podcasts at:
https://www.emg-health.com/omnipresent/?category=podcasts&therapeutic_area=healthcare
