Bariatric Patients

[Lunah]

I recently had a patient who weighed upwards of 500 lbs. She came into our ER with abdominal pain, but there was no way our CT scanner could accommodate her -- our table limit is 350 lbs, and she wouldn't have fit through the scanner gantry anyway. We called all the radiology departments in the area, and the heaviest weight that could be accommodated (at a facility about 50 miles away) was 500 lbs -- so she was still too heavy for that one. We even called a local animal hospital that specializes in horses, but unfortunately they didn't have a CT scanner. The patient was grateful that we went to those lengths to try to find something for her, but it was frustrating. All our usual tools -- x-ray, sono, etc. -- had such limitations because of her size.

We don't have much in the way of equipment for larger patients ... this woman BARELY fit in our widest wheelchair. We are really ill-prepared for the largest patients. I'm just wondering if other facilities have made special efforts to accommodate the really large patients -- what do your ERs have for the bariatric population?

[ghillbert, MSN, NP]

Ah, you assume that there are no contributing factors to smoking? Like peer pressure as a teen, or seeing your parents do it, or the physical addiction of nicotine? Saying you can just stop smoking by not having another smoke is like saying you can just stop being obese by not eating the wrong diet, which you obviously take exception to. Both are addictions with underlying physical and emotional baggage. Healthier lifestyle choices are difficult, whether is be stopping smoking or giving up that extra 1000 calories a day. Addictions require behavioral modifications, education, and an exercise of willpower, of which I believe Americans in general are woefully short on. Hence the number of Americans with unhealthy lifestyles, regardless of what their vice is.

Please do not put words in my mouth. I did not at any point state that there are no contributing factors to smoking. My point was that being a nonsmoker is as easy and hard as not smoking. Fixing obesity is not a matter of never eating again.

Believe me, I know neither is easy. I was a smoker for a long time.... and it really is a matter of just not having another cigarette.

[mama_d, BSN, RN]

Please do not put words in my mouth. I did not at any point state that there are no contributing factors to smoking. My point was that being a nonsmoker is as easy and hard as not smoking. Fixing obesity is not a matter of never eating again.

Believe me, I know neither is easy. I was a smoker for a long time.... and it really is a matter of just not having another cigarette.

Okay, misinterpreted your intent...apologies if I offended. My point was that I see both as addictions, and although it's true that you can never not eat, you can choose to never eat certain things, like giving up red meat or McDonald's. Which is just as hard as giving up cigarettes for some people. I wish that for me it was as easy as just not having another cigarette...I quit smoking both times I was pregnant, and not a day went by that I didn't crave one. It was constantly in the forefront of my mind. Even though I had quit for over a year both times, I started back up again. So I do have a lot of sympathy for those who struggle with a food addiction, which I truly feel those who qualify as bariatric patients have.

[Lunah, MSN, RN]

I had a 350-lb patient this past weekend, and she actually seemed kind of small in comparison to my 530-lb patient of the previous weekend. I also discovered that our ER scale goes up to 880 lbs -- I hope we never take it to capacity! Yikes.

[Aneroo, LPN]

I worked in a hospital that did a lot of bariatric surgeries and will soon be opening a bariatric surgery unit by itself. Even we didn't have a lot of advanced equipment for obese patients. Depending on what was being scanned (head vs. belly) I think it could hold 350-450lbs.

[mwboswell]

It is a medical condition that is caused by lifestyle choices. I'd be incline to approach it the same way I would a smoker.

...AND people who have had any form of STD's, even a genital wart - I would consider it was their "lifestyle" "choice" also (IE: failure to use protection or failure to consider abstinence until marriage/long term committed monogomy).....

[rph3664]

...AND people who have had any form of STD's, even a genital wart - I would consider it was their "lifestyle" "choice" also (IE: failure to use protection or failure to consider abstinence until marriage/long term committed monogomy).....

What about someone who got an STD because their partner was unfaithful, or they were raped?

[mwboswell]

I thought I had edited this cause I went back and thought about just that scenario. I guess I forgot to hit "ENTER" before posting the edited version. But I also contend that these cases are far more infrequent than the others.

[kebsa]

well i can speak from the patients point of view, I hve been nursing for 28years- these days in a limit capacity as i am in an electric wheelchair, i have Multiple sclerosis and i am an amputee- unfortunately i am in the morbidly obese catagory. I did weigh 385 pounds at one stage and got down to 275 by calorie counting and limiting calories to 800. unfortunately last year was bad for me in terms of the MS, i spent over half the year in hospital. My Neurologist sent me to have an MRI of brain and spine to check progression and when i got to the facility they only got me half way in before deciding that it was too narrow, they were worried that the firm fit could lead to burns! I have regained some weight since being in hospital so much and not having the same degree of control on my diet - in terms of overweight and obese people i know i am no light weight but i ams certainly not that bad! i can't help thinking that a bloke with decent sized muscles would have shoulders just as broad! so there must be quite a few people who are too big to fit in the MRI tubes- i am not sure what my options are. And yes, i accept the lifestyle issues in obesity but if you look at any general medical ward you would find that the majority of patients were there because of illnesses that have a life style compenent to them, type 2 diabetes, cardiac disease, COPD, CVA, lots of cancers but for some reason these conditions do not attract the same kind of negative feedback that the obese do! I am notproud of my weight and to have to be turned away from having the scan today was humiliating! If people do opt for bariatric surgery, then they are subjected to taunts about taking the easy way out, again pushing the idea that being fat is being lazy!! given the fact that the population is getting larger there needs to be more done to help people deal with their obesity, and there should be better facilities to deal with the overweight- as for me, they will send me back the mri suite i went to a few years back as it seems their scanner is a little larger and if that fails i guess that will be the end of trying to assess what is happening with my MS

my weight scares me silly, i am doing the best i can with diet but the MS means that excercise is impossible- using a power chair does not burn much energy and if i do try to do a workout to burn up more calories, the increase body temp means my vision goes, i get muscle spasms, i get severe fatigue, my speech slurrs etc- most MS patients are heat affected and even a rise in body temp of 0.5 degree celcius is enough to trigger a psuedoexaerbation that can take a couple of days to pass! this seems like an unwinnable battle

[Lunah, MSN, RN]

i can't help thinking that a bloke with decent sized muscles would have shoulders just as broad! so there must be quite a few people who are too big to fit in the MRI tubes- i am not sure what my options are.

Absolutely. My husband is incredibly fit, and has been lifting weights and/or working out on a near-daily basis since 1988. He is 260 lbs of solid muscle, and he does NOT fit in the standard MRI tube. His shoulders/back/chest are too broad. He had to go to an "open MRI" facility for a brain MRI last year.

[kebsa]

I had wondered about the open MRI's but I live in South Australia and it seems we do not have an open MRI in this state- I am waiting for my neurologist to call back tommorrow and perhaps go back to where i had my first scans done- it seems that the tube is a little larger than the one i went to today- it was still a snug fit and we did not get good spine images because they removed the coil that you lie on to make a bit more space - it did that but the films were not very good at all- not good enough to see if i had any new lesions or not.

i guess i will just have to keep on plodding away at trying to lose weight but i still say that the facilities are behind the times and they should be allowing for people of larger builds- its carzy that someon elike your husband would have trouble getting a scan because of muscle bulk- i weigh a bit more than 265 these days but still less than 300 and it terms of bariatric patients thats almost a lightweight

[greenbeanio]

Kebsa, thank you for sharing your story. And I am so sorry you have to go through this.

This is exactly why I had said that it's not necessarily a lifestyle issue. People always assume that overweight people are greedy and lazy - that it's always about eating junk/too much and not exercising. But it's not always about diet and exercise.

There are conditions that prevent people from exercising, like kebsa's. There's also depression which can literally make your body hurt all over and make you feel so hopeless that it's impossible to push through that.

There are conditions that cause weight gain but the cause of the condition is unknown, like PCOS, so they are hard to treat. And there are medications that cause weight gain.

There are also genetic factors: google obesity + FTO, INSIG2 and PCSK1. These are just three of the genes that alter metabolism to cause obesity - there may be more. Then there's congenital leptin deficiency and Prader-Willi syndrome.

And then there's the obesity caused by viruses - Adenovirus 36 is just one of the viruses that cause obesity. Ad-37 is another one.

There is even research showing that endocrine disruptors in environmental pollutants, increased maternal age, increased time in the thermoneutral zone, and increased sleep debt are all factors related to increased obesity.

When you see someone who is overweight, you cannot possibly know which of these factors are at work. So until the causes of obesity are well known and the cures for the various problems found, I think we need to hold off judgement and focus on compassion and helping instead.