Dr. Shari Welch sees medical complications. She is, after all, an emergency room physician at LDS Hospital. But she's especially bothered by the ones that result from what she calls "risky youth behavior."

She's not talking about the kids injured in gang-style gun battles or high-speed car accidents.

She's talking about body piercing. And while youths and adults have a right to have their bodies pierced, she said, they ought to at least know what can happen.

Drawing from both personal experience and case studies she's found since she started researching body piercing, Welch shares information with doctors and students about a young woman who came into the hospital with an overdose, not breathing. They almost lost her because they had to fight to get her on a respirator. She had several earrings in her tongue. Or the young man who had a penile ring. He was run over in a terrible car accident, and because of the tearing done by the ring and the subsequent scarring, he no longer urinates normally.

She speaks quietly, as well, of the young girl who died last winter. She was 18 and ended up in the emergency room with a fever and adult respiratory distress syndrome. She died during the night.

Tests showed the girl had Group A hemolytic strep, traced to having her tongue pierced just the day before.

Welch said she has also seen nasty cartilage infections that must be treated differently than other infections. People who want earrings around the ear shell would be wise to have just the skin pierced, not the cartilage.

Worse, "because of the intimate nature of some of the pierces, they may not seek medical attention," she said. Even a body piercer magazine notes that "the lay public is afraid of getting a doctor's poor opinion. They know we disapprove. So they are slow to get medical help," she said.

That's not the worst problem, though. Real crisis arises when medical personnel, rushing to deal with a medical emergency, have to wrestle with sometimes complicated jewelry that's piercing various parts of the body. Now they're asking each other what they'll do "when the youth being pierced become middle-aged who need defibrillators. There's no time to get the jewelry out. I guess we will cover it with as big a piece of hospital tape as we can and just shock them. Some might lose a nipple but save their life."

Various Web sites promoting body piercing and even some of the people who do it tell youths that redness, swelling and draining are normal. Unfortunately, by the time some people seek help, they're very sick, Welch said.

Welch had her daughter's ears pierced four years ago. She's had her own done. But the research has convinced her that she should have approached it differently. As many as 23 percent of pierced ears get an infection, and her daughter was no exception. Now she believes that in the case of all piercing, "you ought to at least be touching base with the family doctor. He might want to put you on antibiotics. No research says there's no complication.

"If you get body pierced, it can affect your heart valves if they're not 100 percent normal. The risk is small, but the results are so catastrophic. People with cystic fibrosis, diabetes, wound infections should all be on antibiotics first."

In an ideal world, every body piercer would be backed by a physician, much like a physician's assistant is, she said. "They should have to have a doctor behind them if there's any problem. And some things are a whole lot easier with anesthesia. Let's throw in a little help from modern medicine. And have every patient give informed consent. Give them something to read, a video, something that explains what's happening."

When someone has a spinal tap, he talks with the doctor about the risk and signs a paper that says he understands those risks. That's what should happen with body piercing, she said.

Welch has visited piercing parlors and mall kiosks that offer simple ear piercing, as part of her research. When she met with a body piercer, "it was clear he did not know about sterile technique. Instruments are sterilized in an alcohol-based foam, while a doctor would be using betadyne. Gloves were not sterile, and the young man pulled jewelry out of a dusty drawer."

Still, she's more afraid of kiosks that use a "piercing gun." The risk of infection is greater than with the old needle-and-cork method. And the kiosks generally offer less training to employees than piercing parlors, she said.

Some parlors have medical equipment, like the special table an OB/GYN uses. "If you saw that, you might think he's properly trained. But across the country, there's no licensure for body piercers. Anyone can set up shop. The Health Department checks that some businesses have an autoclave but doesn't check that it is used or used right.

"Just the three cases were enough for me. One died, one almost died and the other will never (urinate) right again. If they had more information, would they make a different choice? I'm thinking a lot of kids won't. But others might."

E-MAIL: lois@desnews.com