BMI at which you give up on procedures

[Laryngospasm]

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Just curious, At what BMI does everyone give up and not schedule procedures.. the worst are cervical rfas. Also any tips other than CLO for these patients. Of course I do council them on weight loss as well.

 

[callmeanesthesia]

My procedure table has a 500 lb weight limit.

 

[ateria radicularis magna]

A Jedi doesn’t rely on antiquated metrics to judge a kitten too fluffy.

 

[Laryngospasm]

A Jedi doesn’t rely on antiquated metrics to judge a kitten too fluffy.

Yes I know.. but I mean in general. I don’t get too many bodybuilders in my clinic. Typically if their BMI is 55.. they are shaped like an apple.

 

[Orin]

Depends on the procedure but the limiting factor is the equipment with the length of the needle, RF electrodes, kypho cannula, etc. I've had to adjust some approaches and break out some harpoons, but haven't yet had to cutdown to get a needle deeper outside of implants.

Our OR tables go up to 1000 lbs, but I don't think I've broken 600 lbs yet.

 

[deleted131481]

If they are over 400lb then weight loss is #1,2, and 3 on the problem list. Injections are just going to be distractors without meaningful relief.

 

[Ferrismonk]

Will attempt if needle is long enough and table can handle it. Obviously we discuss weight loss and injection is only temporary relief to allow him/her to exercise and lose weight.

Usually I couple with aquatic therapy.

 

[DODOCSS]

Will attempt if needle is long enough and table can handle it. Obviously we discuss weight loss and injection is only temporary relief to allow him/her to exercise and lose weight.

Usually I couple with aquatic therapy.

whale therapy

 

[MD87]

Direct referral for L5/s1 ILESI, 600 pounds. Thanks to Steve’s technique. I got away using a 7inch quincke. 6 inch tuohy needle wouldn’t have made it. Whether it helps the guy is a different issue.

 

[deleted875186]

Direct referral for L5/s1 ILESI, 600 pounds. Thanks to Steve’s technique. I got away using a 7inch quincke. 6 inch tuohy needle wouldn’t have made it. Whether it helps the guy is a different issue.

I’ve found the long toughy can reach any epidural space, the skin can be indented quite a bit and the ligament holds the needle. Would not attempt a TFESI though.

 

[Taus]

I’ve found the long toughy can reach any epidural space, the skin can be indented quite a bit and the ligament holds the needle. Would not attempt a TFESI though.

Break out the duct tape to prep for caudal…. Same role as as the pannus retractor (med student) for hip injection with mega BMI

 

[MD87]

I’ve found the long toughy can reach any epidural space, the skin can be indented quite a bit and the ligament holds the needle. Would not attempt a TFESI though.

I would have agreed with you. Until this guy lol.

 

[Dawkter]

There has to be BMI threshold where these injections are just not going to help at all. We are probably doing the patient a disservice by attempting these procedures and the steroid certainly will not make weight loss easier.

In my mind, this BMI cutoff is probably around 50.

 

[deleted875186]

There has to be BMI threshold where these injections are just not going to help at all. We are probably doing the patient a disservice by attempting these procedures and the steroid certainly will not make weight loss easier.

In my mind, this BMI cutoff is probably around 50.

I have to agree. Patients get angry if you tell them they need to loose weight, don’t want to hear the truth.

 

[cowboydoc]

I have to agree. Patients get angry if you tell them they need to loose weight, don’t want to hear the truth.

We could substitute MME in place of BMI, and this conversation would be the same.

 

[Agast]

I have told many patients they need to lose weight. You have to work on your delivery and come up with helpful suggestions. What is their relationship with food, are they cooking or eating out. If you don’t grow up thinking about nutrition you have no idea where your calories are coming from. Not one of my patients has gotten mad at me for discussing this. I will occasionally prescribe topiramate, bupropion, phentermine for people who need help. Patients seem to do well with CICO or intermittent fasting. They can download Lose It or My fitness pal for free calorie tracking.

 

[Ducttape]

It's simple to give patients a referral to a multidisciplinary bariatrics program.

At those locations, it's not all about the surgery. There are nutritionists, psychologists and physicians who all see the patient.

 

[SpineandWine]

Unlikely if they're 500 pounds, they haven't thought about their weight from 300 pounds until they were 500 pounds (over at-least couple years). Unless they are open to bariatric surgery, it's unlikely (statistically speaking) they will lose weight with nutrition/speech you give. My thought on this is that they are not surgical candidates so their only hope of relief is injections you provide. So my table in hospital can support 350 pounds, have to go to OR for >350 pounds (no weight limit for my procedures)

 

[Ducttape]

Unlikely if they're 500 pounds, they haven't thought about their weight from 300 pounds until they were 500 pounds (over at-least couple years). Unless they are open to bariatric surgery, it's unlikely (statistically speaking) they will lose weight with nutrition/speech you give. My thought on this is that they are not surgical candidates so their only hope of relief is injections you provide. So my table in hospital can support 350 pounds, have to go to OR for >350 pounds (no weight limit for my procedures)

a lot of things are unlikely.

it is unlikely that i will ever run a marathon. it is unlikely that i will own one of lobel's sports cars. it is unlikely that we will ever stop this extreme partisan political BS that deludes almost all of us from right and left.



it is unlikely that Michigan will beat that $#^%ing BS team from down south - oh wait, that did happen!!!!!


its the right thing to do, from the patients health perspective, and even if your N is 30, or 50, or 100, even just 1 person losing weight will have significant health benefits.

i can visualize mentally at least 30 people that i have counselled that have lost 20+ pounds, including a few that are off their anti-hypertensives or diabetes meds.


a steroid injection is only a temporary spot treatment for a couple of months, if that. steroids in this group carry significant risk. RFA is different, and will give you that.

 

[nvrsumr]

I don’t get into weigh loss with patients. They have a lot of pain doc options locally and me telling them their pain is due to weight goes over about as well as telling them it’s all in their head

 

[bedrock]

I don’t get into weigh loss with patients. They have a lot of pain doc options locally and me telling them their pain is due to weight goes over about as well as telling them it’s all in their head

Agree with this. IMHO, patients just shut down and don't listen to you after you mention their weight. However........ I don't completely forget about it.

Once I've relived 80% of their radiculopathy with an ESI, then I tell them if they lose weight this improves the chances of the shot lasting longer, same thing with hip/knee injecctions, hell I even mention i after RFA, which is less critical, but still good for their overall health. But its not the first or second thing I discuss with a patient.

 

[Orin]

We don't need steroids. I use that expectation of a steroid injection as an opening to talk about weight, and provide counselling on the importance of diet over exercise for weight.

I try to convince them that although Big Government pays me to fill them full of steroids, there's a better way if they're willing to put in the work, and I don't want them getting pumped full of steroids and getting diabetes, etc.

Then I then offer ablations, implants, etc so I can pay for my pointy shoes.

 

[BobBarker]

I tell them to lose weight all of the time. I used to be a lot heavier and that helps the discussion. The long time patients ask me how I lost weight so sometimes they ask me for advice. I prescribe topiramate to help with their pain and weight and encourage they start weight watchers.

 

[ateria radicularis magna]

I tell them to lose weight all of the time. I used to be a lot heavier and that helps the discussion. The long time patients ask me how I lost weight so sometimes they ask me for advice. I prescribe topiramate to help with their pain and weight and encourage they start weight watchers.

How much did you lose?

 

[BobBarker]

Probably 60lbs since fellowship. Need to lose 25 more to be “normal” BMI.

 

[SpineandWine]

a lot of things are unlikely.

it is unlikely that i will ever run a marathon. it is unlikely that i will own one of lobel's sports cars. it is unlikely that we will ever stop this extreme partisan political BS that deludes almost all of us from right and left.



it is unlikely that Michigan will beat that $#^%ing BS team from down south - oh wait, that did happen!!!!!


its the right thing to do, from the patients health perspective, and even if your N is 30, or 50, or 100, even just 1 person losing weight will have significant health benefits.

i can visualize mentally at least 30 people that i have counselled that have lost 20+ pounds, including a few that are off their anti-hypertensives or diabetes meds.


a steroid injection is only a temporary spot treatment for a couple of months, if that. steroids in this group carry significant risk. RFA is different, and will give you that.

1) Go BluE! Hopefully we'll beat georgia
2) Talking to patient for weight loss and causative for pain offends them and is bad for patient satisfaction.
3) Agree- it's good but they know they're big. They don't need someone else explaining it to them - unless they ask for it IMO - otherwise, they'll be less open to it. Need to get relationship established first.