Screening Your Play Partners

 Posted by on June 2, 2010
Jun 022010

OR  How to Avoid Becoming a Defendant in a Wrongful Death Suit

Playing hard and getting your bottom’s heart rate up to a respectable level with pain, fear or sexual excitement is not a bad thing and often the goal of a scene.  How do you know your play partner can handle what you’re giving?  I’m sure most people’s idea of safe, sane and consensual doesn’t involve a medical complication, a conversation with a 9-1-1 operator or a visit with the paramedics and a significant emotional event.  The goal of this brief paper is to give you a medically based, logical approach to estimating the risk of playing with a given sub.  This system is based on a pre-operative risk assessment used in primary care that places patients into risk categories based on their history, functional capacity and the physical demand of the type of procedure they are about to endure.  This system is easy to understand, not time consuming and gives you an estimate of how hard you can push a potential play partner.  This article is not meant to be a substitute for an office visit with a physician.  I would recommend that if there is any question about a person’s ability to tolerate strenuous activity that they consult their physician and obtain medical clearance before engaging in said play.

The first step in any screening is a taking a detailed history from your potential bottom.  The history is 90% of this process and honest answers from a submissive when answering medical history questions is essential.  It may be valuable to emphasize this to your play partner and explain to them that this process isn’t about disqualifying them from play, but more about finding the safe level of play for them to avoid unwanted complications.  Age is important.  Among patients over 40, the risk of a cardiac event after an operation has been estimated at 1.4% and post-operative cardiac death was 1%.  That’s not insignificant, but he when the American College of cardiologists and the American Heart Association came up with their perioperative guidelines a listed in age 70 years old is a minor predictor of cardiovascular disease that had not been definitively proven to independently increase the perioperative risk of cardiac event.  More significant than a person’s age is their medical history.  Major predictors of myocardial infarction include a recent myocardial infarction (heart attack) or severe angina.  Recent myocardial infarction is usually defined as within 6 months.  If a person undergoes a stressful event such as in operation within 3 months of having a heart attack they have 36% chance of having another heart attack and dying, but if they wait until 6 months after having a heart attack to engage in stressful activity this risk drops to 5%.  Severe angina is uncontrolled or unstable angina.  This is chest pain that is unpredictable or increasing in severity and should give anyone pause.  If someone has ever had chest pain is not necessarily a disqualifying symptom.  There are many causes of chest pain and most of them are noncardiac in origin.  If someone admits to chest pain, ask about a recent stress test.  If a person has had a stress test, especially a stress echo or a thallium stress test within the last 1-2 years and it was normal, it is much more reassuring that they did not have cardiac disease and are safer to engage in intense play.

Other major risk factors predicting cardiac events include the presence of arrhythmias and recent procedures such as cardiac stenting.  Diabetes is one of the most important medical conditions to inquire about when taking a medical history from a new play partner.  The person that has diabetes mellitus should be treated as a person that has the equivalent of coronary artery disease.  Many diabetics will only require oral hypoglycemics (pills) to control their diabetes.  Diabetics that require treatment with insulin to control her blood sugar have a more severe disease and have a major predictor for cardiac complication.  It is worth asking diabetics about episodes of hypoglycemia and keeping a ready source of sugar on hand, such as orange juice, hard candy or glucose tablets, when playing with these individuals because stress can induce hypoglycemic states. Diabetics need kink too, but taking precautions will minimize the risk to these individuals.

In the course of taking a medical history of maybe worthwhile to ask the person when was the last time that they visited a physician and had a routine checkup.  It always amazes me the number of people that I see who had not been to a physician in the last 20 years and I wind up diagnosing with serious medical conditions such as diabetes.  When interviewed, these patients always deny having any serious, chronic medical conditions and are surprised when I tell them that they have uncontrolled diabetes.  Finally we should briefly discuss the risk of obesity.  The prevalence of coronary artery disease and its risk factors is greatly increased in obese people.  The obese are also less likely to engage in routine physical activity and will most likely have a decreased capacity for intense activity.  It is worth noting that an obese person that regularly engages in strenuous exercise is less at risk then person within normal body mass index but doesn’t exercise at all. So it is important to take a detailed history and to emphasize to potential play partners the need to answer medical questions honestly.

The next step in screening involves assessing a person’s functional capacity.  This is a lot like judging their ability to endure future play based on past performance.  In general when I am trying to clear somebody for a major operation I simply ask him questions.  Can you climb 2 flights of stairs or walk 4 blocks without becoming winded?  If they answer yes I know that they have good functional capacity to handle the stress of a significant operation.  One metabolic equivalent or MET is defined as 3.5 ml O2 uptake/ kg per minute.  What does that mean? Here are some other activities that will give you an idea of what a MET means.  If a person can dress, eat and use the toilet without exhaustion they are capable of achieving 1 MET.  Not sure how many METS are required for toilet play… If a person can walk up one flight of steps or walk up a small hill they can achieve 4 METS.  This is the usual cut off point for clear somebody for surgery.  If a person cannot achieve 4 METS they’re at increased risk for cardiac complication from surgery.  If a person can perform heavy work around the house such as scrubbing floors lifting and moving heavy furniture without exhaustion a can achieve between 4 and 10 METS.  Someone engaging in strenuous sports such as swimming, single status, football, basketball and skiing is capable of achieving > 10 METS.  So it is important to ask a person about their exercise habits.  If they exercise regularly and can achieve > 10 METS they’re a good candidate for intense play.  The prospect of intense play is the sole motivation for me continuing regular exercise!

The last part of the screening is not really based on medical research.  In preoperative screening I would estimate the risk of the given procedure.  It is easy to see that vascular surgery or abdominal surgery, such as an appendectomy, would be more strenuous to a person than a more minor procedure such as cataract surgery.  There really aren’t any studies that report on the physical demands of CBT versus inverted suspension while being single tailed.  I’ve often wondered about the physical demands of things like intense breath play, and have even thought of ways to study the effects of this type of play, but sadly nothing has made it into the medical literature yet.  (If anyone has any experience with writing grant proposals to the NIH, I’d love to see if he could figure out the wording on something like this!)  High-risk procedures include vascular surgeries and often result in perioperative cardiac death or nonfatal myocardial infarction.  Intermediate risk procedures generally carry a risk of between 1 and 5% rate of cardiac death or nonfatal myocardial infarction.  These procedures include head and neck surgery, intraperitoneal and intrathoracic surgery, orthopedic surgery and prostate surgery.  Low risk surgeries include surgeries that carry a less than 1% risk of cardiac death or nonfatal myocardial infarction.  These procedures include ambulatory surgeries (same day surgeries), superficial surgeries, cataract surgeries and breast surgeries.  You’re just going to have to use your best judgment to estimate the risk of the type of play you are going to engage in.  The more intense edgier scenes the results a profound submissive response and endorphins release are going to equate more with a higher risk procedure.  Keep in mind that while some scenes can be very intense it is hard to imagine one that would approach the risk of a high-risk surgery such as an aortic aneurysm repair, although I’ve seen some scenes that would.

In conclusion, prior to engaging in intense play with a new play partner it is wise to medically screen them first.  If they have risk factors, have a low functional capacity, or if the type of scene you have planned in particularly demanding or long in duration, it may be prudent to have the prospective sub medically screened by a physician to avoid an unwanted complication and minimize the risk of play.  The difference in risk can be significant.  For example a person with no risk factors that undergoes a relatively minor procedure may only have a 0.4% chance of having a cardiac event during or after the procedure.  A person with several risk factors, things like history of a heart attack, history of heart failure, ongoing chest pain, diabetes requiring insulin, a history of kidney issues  or undergoing a high risk procedure, may have a risk as high as 5.4%.  I’m not suggesting that you avoid playing with people that may have medical issues.  What I am advocating is to take precautions if you do and to minimize the risk to them and to you.  After all it’s about having a good time and not really about getting the opportunity to practice your CPR!