New York Times must read article.

[CaraOC]

http://www.nytimes.com/2016/09/26/h...l?smid=nytcore-ipad-share&smprod=nytcore-ipad


Very interesting article on medical treatment of fat folks. Very interesting read.

 

[CaraOC]

@trace I thought about you when reading this.

 

[DSRIGGS]

Unfortunately that is the reality and it isn't going change. Before I moved to Arizona in 2002 I had TERP (bad decision for a few reasons) and when I was there my first week on the new job i went to a Dr because I was having bad pain. The NP I saw just looked at me, shook her head and said you need to lose weight or you are going to die. I was about 315 at that I'm and the bitch hadn't even asked me anything before making that comment. My response was do you think I don't know I am over weight buy you and I both know that has nothing to do with why I an here so are you going to do your job or not? You should have seen the look 9n her face bit at least then she did examine me and gave me some pain meds and flow max to help me urinate.

We are more difficult to treat but that doesn't mean we shouldn't have received better care. It is sad.

 

[k9ophile]

This attitude is precisely why I went to another doctor for my gallbladder. Our insurance was very restrictive about what they would pay if we went out of network. The surgeon (only one at my small hospital) was notorious for his disgust of fat females. Luckily, there was another hospital in network 30 miles away and I liked the only surgeon who was on staff there. Such are the perils of rural living with small hospitals, yet I was happy to go that 30 miles. I referred many other fat women to the other doc. The fatty hater eventually moved because his wife hated small town living. His post-op complication rate was unacceptable, yet management never would have gotten rid of him due to the difficulty of finding docs who want to live in smaller towns.

However that pales to another doctor I worked with who sold dubious remedies who "gave" me something for my weight and then got insulted when I gave it back to him. I wasn't even seeing him as a patient. We both worked for the same consulting company.

Also, did you notice the patients were all women? I'm not saying men don't get fat shamed, but I'll bet it's less than women.

 

[trace]

Wow. That is sooooooo exactly, sadly, what I have experienced. One orthopedist didn't even bother to wiggle my right leg around in order to pretend he was interested in my pain, what it might be, or from where it was originating. He just handed me a folder for the weight-loss surgeons down the road (who happen to do banding, VSG or RNY only, no thank you).

I think in my post-raising-children-life, I am going to use my time to advocate for fat people and fair medical treatment. The statistics continue to stun me, and no matter how many times I read about it, I feel like crying that so many people in the US medical system are being treated this way.

 

[Munchkin]

Bad things happen when you are young, stupid, and fat. Once upon a time in my very poor days I was working hard for not much money and trying to get my H through school. The one advantage I had was working for a company that gave out jobs based on test scores. And I can pass almost any test. It's a gift, sort of. I put in my time took the test and qualified for virtually every job the company had! I accepted one of the top jobs they had and I was thrilled. Until I wasn't and they took it away from me. I knew there was a good chance I was doomed when I walked in to the physical and the doc had the old half a knife, the spoon with a hole in the middle, and the fork with half the tines cut off in a frame on the wall. He was surprised I could touch my toes and every other word out of his mouth was that I was fat. They didn't want me to have the job because it was man's work to begin with and second, I was fat. They colluded and lied. I proved them out to be what they were but by the time I 'won', all the good jobs were gone and I was forced to settle for less or be laid off.

If I had had more means, I would have sued the pants off them and retired REALLY young!

 

[DianaCox]

Sarah is, as usual, the poster child .... and the fact that she has lymphedema as a primary cause of her size, is only mentioned in the picture caption. I don't know that she had any problem being diagnosed with it because of her weight.

(If I sound a little bitchy, it is because Sarah was part of the OvertHere gestapo/moderator cabal that killed the DS board. She was one of those who were uber-sensitive about suggestions that she picked the wrong surgery.)

 

[newanatomy]

Is lymphedema caused by obesity, does obesity cause lymphedema or are they unrelated?

I looked it up, so I got my question answered:

What causes lymphedema?
One of the causes of lymphedema is surgery to remove lymph nodes , usually during cancer treatment. Normally, lymph nodes filter fluid as it flows through them, trapping bacteria, viruses, and other foreign substances, which are then destroyed by special white blood cells called lymphocytes. Without normal lymph drainage, fluid can build up in the affected arm or leg, and lymphedema can develop. Medicines such as tamoxifen (Nolvadex), radiation therapy, and injury to the lymph nodes can also cause lymphedema. This type is called secondary lymphedema.

Primary lymphedema can be present at birth or develop during puberty or adulthood. The cause of primary lymphedema is not known.

 

[DianaCox]

A more in-depth answer:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393748/

Lymphedema and Obesity: Is There a Link?

CONCLUSIONS
The link between obesity and lymphedema continues to be elucidated. Increasing evidence supports the concept that this relationship is reciprocal such that obesity impairs lymphatic transport capacity and impaired lymphatic function promotes adipose deposition. This association provides a mechanism for the development of primary lymphedema in superobese individuals and the increased risk of lymphedema in obese patients. Based on the studies reviewed in this article, we have provided a hypothetical model for the pathologic process of lymphedema (Fig. 3). In this model, lymphatic injury starts the cycle of lymphatic dysfunction, which leads to accumulation of interstitial fluid. Impaired lymphatic clearance results in inflammation and promotes fibroadipose deposition. In turn, fibrosis and adipose deposition further impair lymphatic function, resulting in a feedforward loop. We hypothesize that obese patients are at higher risk for lymphedema because they have baseline impaired lymphatic function. Based on clinical and laboratory studies demonstrating that the pathologic changes in the lymphatic system resulting from obesity are at least partially reversible with weight loss, we hypothesize that efforts be aimed at weight loss/management in patients who are at risk for developing primary or secondary lymphedema.

 

[newanatomy]

Thank you, Diana

Does the risk go away after losing the weight?

 

[Clematis]

I also found the anesthesia dosing interesting and how propofol for MO could be dangerous if given at body weight dosage. It reminded me of the couple of people here who took days to come out of anesthesia, like @Amey

 

[Amey]

Yup.....I could NOT wake up to save my life. I heard people around me and was kind of in and out of it. The nurses were upset with me because I wasn't sipping water and couldn't walk. They tried to make me get out of bed and walk and I mostly stumbled and it took 3 of them to hold me up and they almost had to pick me up off the floor. Even the 2nd day I had to use a walker because I still felt like I was drunk, dizzy and the ground kept moving on me.