Abdominoplasty, Anorexia and Ethics

[Halinja, BSN, RN]

I'm a little disappointed in one of our surgeons. Today he did abdominoplasty on a 110 lb anorexic. Not even a recovered anorexic, but someone still strongly in the grip of the disorder. The pt doesn't even want to eat a cracker with the oral pain meds.

It feels so wrong. The pt already has a hugely distorted body image. By doing the surgery he has played into the pt's delusion. Reinforced it, even. And on a different level...the pt apparently hasn't eaten for two weeks. The patient's body was just put under the tremendous stress of major surgery. How is the patient going to heal when the body has no fuel in reserve, and the patient won't take in any fuel?

Disappointed may be a little bit of an understatement...

[TheCommuter, BSN, RN]

Although I probably don't have the entire story, it is increasingly sounding as if the physician might be unethical and a tad greedy.

[Blee O'Myacin, BSN, RN]

Without all the info, I can't condemn the surgeon. Perhaps s/he was trying to return a good body image to this person, even if they are already too thin to begin with - hanging skin and separated abdominal muscles will stay the same, no matter the weight gain or loss.

I've had surgery where I haven't wanted crackers with pain meds. PMs don't make me nauseous, but the food did. (I usually can't pass a sandwich without getting to know it a bit better, so anorexia is not an issue here).

If you are in a position to speak to the surgeon privately over the care of this patient, then I encourage it. Knowing why he did the surgery might help with the care of this patient. I guess that in our lawsuit happy country, I can't imagine a doc taking on a patient who is so high risk for complications and non-compliance - especially for a cosmetic procedure.

Blee (still trying not to be jaded and cynical and losing ground daily :nuke:)

[mama_d, BSN, RN]

Was it purely for cosmetic reasons?

The reason why I ask is that I qualify for an abdominoplasty due to diastasis recti, and I only weigh about 115 lbs. I'm sure that if I chose to go and have it done, I'd have people thinking I was delusional. I chose to just have an umbilical hernia repair done instead b/c the recovery is so much easier. So I'm together at the bottom but still seperated at the top.

Even if was for just cosmetic reasons, is it possible that he felt that this may have helped to fix her body image problems and therefore helped her to recover from her anorexia? I know it's backwards thinking, but I'm truly hoping that his heart was in the right place even if it seems like his head wasn't.

[Halinja, BSN, RN]

Yes, it was for cosmetic reasons only.

[TiredMD]

Yes, it was for cosmetic reasons only.

I don't really understand how you know so much about this case. Are you the OR or clinic RN for this surgeon?

Getting a case done isn't just a matter of the surgeon doing it. The anesthesiologist has to sign off on it as well, and they are notoriously nervous about cardiac risk factors and electrolyte disturbances, both of which are reasonably common in anorexics.

In addition, a 110lbs female doesn't immediately strike me as common in true anorexia. Is she very tall?

[Tweety, BSN, RN]

My problem with this is that the patient isn't in any kind of recovery, even if they are relatively healthy at 110 lbs. Nothing wrong with returning someone's self-esteem but I'm with Commuter, sounds more like greed and unethical behavior to me. But the patient is the consumer and has their rights too.

[Tweety, BSN, RN]

I don't really understand how you know so much about this case. Are you the OR or clinic RN for this surgeon?

Any nurse involved in any aspect of the perioperative care is going to be intiminately involved in the details of their patient. It's part of nursing and what we do.

[TiredMD]

Any nurse involved in any aspect of the perioperative care is going to be intiminately involved in the details of their patient. It's part of nursing and what we do.

I find it unlikely that a surgeon, anesthesiologist, and hospital would all sign off on a high-risk cosmetic surgery that clearly violates standards of acceptable care. Making a claim like this begs questions about background. I find it more likely that this is a postop nurse who made assumptions about a patient's background, rather than possessing real knowledge, which is why I asked.

I'm amazed you would take a story like this at face value.

[northshore08]

I have seen pts come into the ED with immediate complications from cosmetic surgeon's office procedures that were quite extensive. Could this procedure have been done in that kind of setting?

Maybe a hospital did not have to sign off on this procedure.

Just wondering.

[Tweety, BSN, RN]

I find it unlikely that a surgeon, anesthesiologist, and hospital would all sign off on a high-risk cosmetic surgery that clearly violates standards of acceptable care. Making a claim like this begs questions about background. I find it more likely that this is a postop nurse who made assumptions about a patient's background, rather than possessing real knowledge, which is why I asked.

I'm amazed you would take a story like this at face value.

Fair enough.

But aren't you making presumptions when you say "I find it more likely that this is a postop nurse who made assumptions......" :)

It surely requires a little more details, but face value is all we get at Allnurses when patient confidentiality is involved.

I have to accept at face value that the op knows the person is an active anorexic even at a healthy weight of 110 pounds.

When I presume that the 110 person needs counseling rather than plastic surgery I'm taking a leap and I admit that.

I never said the surgery was unsafe or didn't meet acceptable standards of care. However, at face value, it does violate my own personal ethical values.

[elizabells, BSN, RN]

In addition, a 110lbs female doesn't immediately strike me as common in true anorexia. Is she very tall?

While the DSM-IV does specify a weight criteria, an eating disordered person may not meet that. It is entirely possible for a person to have a severe eating disorder (ED-NOS, for example) without having a BMI of 16. I know the OP did use the term "anorexia", but it's not the most accurate of diagnoses.