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Tattoos sound a medical alert: EMTs prefer alert necklaces but say tattoos are better than nothing

This article first appeared in the St. Louis Beacon, July 20, 2009 - A little over a year ago, Vienna, Ill., Correctional Center officer Todd Walsh got his second tattoo.

But unlike the firefighter helmet-wearing bulldog wrapped in an American flag that covers his left upper arm, the new design on his right wrist is a more practical choice: a medical "star of life" emblem with the word "diabetic" underneath.

The Type I diabetes Walsh, 37, has had since childhood has caused occasional, sudden plunges in blood sugar that rendered him unconscious. The wrong treatment -- or no treatment -- could kill him.

Tired of replacing medical alert necklaces that often get broken on the job, Walsh opted for a more permanent solution, just in case it happens again.

"If I pass out, people are going to see my tattoo," Walsh said.


The location of Walsh's medical tattoo -- on a wrist, not part of another design -- increases the chance that emergency medical personnel will notice it, according to Kim Bacon, West County EMS Community Liaison and a paramedic for more than 20 years.

"We are trained to look for medical alert bracelets or necklaces; we would see a tattoo in that area," Bacon said. "But if it's embodied in artwork, we could very well overlook it."

When Walsh showed his tattoo to Dr. Saleh Aldasouqi, his diabetes specialist in Cape Girardeau, Aldasouqi was fascinated. After learning everything he could about tattooing from a local studio, he gave a presentation on medical tattoos at the annual meeting of the American Association of Clinical Endocrinologists in May.

Aldasouqi,  who noted that low blood sugar is often mistaken for drunkenness and that medical jewelry can snap off in an accident or fall, sees a place for medical tattoos, if the practice is regulated.

In Missouri, tattoo artists must be licensed, and tattoo businesses are required to meet certain standards for sanitation.

Before getting any tattoo, diabetes patients should check with their doctor first.

"If their blood sugar is not under control, diabetics can have a higher rate of infection or poor healing. There may be an allergy to the ink," Aldasouqi said.

Endocrinologist Dr. Garry Tobin reluctantly accepts the idea for tattoos that alert health-care providers to diabetes or penicillin allergies. Tobin who teaches at Washington University School of Medicine, said, "I'd rather they have something than nothing, so if this is what they want to do, I'd be glad to see it," Tobin said.

Dr. Edmond Cababbe, a plastic surgeon with St. Anthony's Medical Center, knows a lot about tattoos, having donated his time to remove gang-related emblems from former gang members. Tattooing is a serious, invasive procedure, he said, carrying risks for HIV and hepatitis. One reason they should never take the place of a medical alert jewelry is the possibility a person's circumstances may change.

"If somebody was obese and diabetic, and he lost weight, he may not be diabetic after he loses the weight," Cababbe said.


A general medical alert such as the star of life that Walsh has but without words is a "pretty common" tattoo, according to Andy Bell, manager of Fenton's Universal Ink tattoo studio. At Iron Age Tattoo in the University City Loop, several artists have created by request tattoos that read "DNR," which stands for "Do Not Resuscitate." DNR is an order not to perform cardiopulmonary resuscitation (CPR) on someone if his or her heart stops beating. It's a decision usually made by a person with a fatal disease who does not want a prolonged life of suffering.

Iron Age artist Joe Cumbee tattooed DNR on a man's chest a few years ago. If the person changed his or her mind about having CPR, he'd have two choices, Cumbee said: "Cover it up with another image or get it lasered off."

Whether to keep or remove a DNR tattoo has no practical consequences, said Bacon, because DNR orders are only followed if they're in the form of a complete, written authorization.

"A tattoo does not meet the legal requirements that we need not to resuscitate," Bacon said.


St. Louisan Chris Reilly's 10-year-old diabetic daughter enjoys wearing her medical alert jewelry. "She still thinks it's cute," Reilly said.

But if her daughter were in danger of passing out, and balked at wearing a bracelet or necklace, Reilly would consider a medical tattoo -- a decision parents of children under 18 are allowed to make in Missouri.

"It's just another choice," Reilly said. "I would be sure she had all the information and she would understand that it's a permanent thing."

Ally Klein has a 19-year-old daughter with diabetes. "At this age, I would let her make that decision. It's her body," said Klein, who also lives in St. Louis.

But when her child was younger, Klein would have never considered it. "I don't think I have a right to put something like that on my daughter," Klein said. "I think it's a label."

Tattooing children can have unintended consequences later in their lives, warned Marie Davis, executive director of the Greater Metro St. Louis Chapter of the Juvenile Diabetes Association.

"When you grow old, your little emblem is going to look like a prune instead of a medical alert bracelet," Davis said.


Davis favors another kind of permanent medical alert: a computer chip inserted just beneath the skin, similar to those sometimes contained in medical jewelry.

"If we had a chip and it was always located in the same place on every person, and they had a machine to ID what the chip said, that would be better," Davis said.

But implantable chips are controversial and not widely used. Critics warn of a future in which medical information is no longer private and people can be tracked by GPS equipment inside the chip.

Cababbe supports medical chips, even though they're still not a perfect solution. He stressed that implanting chips is another invasive procedure, albeit one that's performed in a medical setting.

"A chip like this would probably be inserted by a physician, not a tattoo artist," Cabbabe said. "So the risk of passing diseases is probably smaller."

Nancy Larson is a freelance writer in St. Louis.

Nancy is a veteran journalist whose career spans television, radio, print and online media. Her passions include the arts and social justice, and she particularly delights in the stories of people living and working in that intersection.