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BODY WATCH : What’s Behind the Black and Blue?

SPECIAL TO THE TIMES

Ever found a mysterious black-and-blue mark on your body and wondered how it gotthere? Whether the result of major trauma or an inadvertent bump, bruising is one way to assess damage to tissue.

The factors involved in what makes a bruise and how it heals are fairly simple. In an effort to get to the bottom of bruising, we went to three specialists who deal in bruises: Dr. Philomena McAndrew, a Los Angeles hematologist; Dr. William Shankwiler, a Pasadena orthopedic surgeon, and Dr. Patrick Abergel, a Santa Monica cosmetic dermatologist. Here’s what they say.

Question: What are the mechanics of a bruise?

Answer: Bruising is nothing more than bleeding under the skin. When tissue is injured and blood vessels rupture, bleeding begins even when the skin’s surface isn’t broken.

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The body’s defense system reacts by releasing chemicals that begin the clotting process. As blood coagulates and percolates to the skin’s surface, the traumatized area may appear purple, blue and swollen.

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Q: Why don’t some bruises show?

A: The deeper the bruise, the longer it may take to appear on the surface. Bruises that bleed deep into muscle may not appear on the surface at all, but result in a lump.

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The look and size of a bruise can also depend on the extent of the blow, the proportions of the area traumatized and individual blood-clotting abilities.

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Q: How does a bruise heal?

A: The body’s natural ability to break down and cleanse away old coagulated blood begins as soon as a bruise appears.

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Circulation gradually moves dead cells out of the system, causing a bruise to change color, lighten and eventually disappear.

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Q: Why do some people bruise more easily than others?

A: How much bruising occurs is an individual matter. Bruises appear more readily on the surface of thin-skinned people. The elderly tend to bruise easier because blood vessels become more fragile with age.

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Bruising is tied to personal body chemistry and especially the ability to coagulate blood.

Low blood platelets--the glue that holds blood cells together--is a sign of a blood-clotting deficiency. Easy bruisers may lack Vitamin K, a necessary nutritional catalyst in the blood-clotting process.

People taking blood-thinning medications, such as aspirin, will also have trouble coagulating blood. People with a history of prolonged bleeding or hemorrhaging are at risk too.

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Q: How should a bruise be treated?

A: Forget what you’ve heard about putting a cold steak on a bruise. Doctors say ice your bruise, then eat the steak. Elevation and compression are also important during the first 24 hours. All three help to constrict blood vessels and slow blood flow.

Afterward, moist heat, range-of-motion exercises and massage will help to reabsorb the bruise.

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Q: When should a bruise become a worry?

A: Bruises come and go, but if you find yourself in any of the following situations, your best bet is to seek medical attention:

* If you notice spontaneous bruising that looks like little red dots (sort of like a hickey). This could be a sign of a serious blood platelet deficiency.

* If you bruise from very mild traumas, such as brushing your teeth.

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* A heavy blow to the head may or may not result in a bruise you can see, but should be checked out. An internal bruise in the head can be deadly.

* If you have a bruise that turns red and hot or doesn’t go away.


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