Special Ambulance for Fatties -

[anon-y-mouse]

Wrong again. I said that the issue could be addressed better in a long-term physician/pt relationship, where the doc gets to know the pt.

Perhaps I'm having trouble comping up with specifics because we're not talking about a specific pt. situation. You can try approaching it by talking about how the extra weight affects the pt health. You can talk about how it limits them socially. Try to find something that is important to the pt that can be incorporated as a motivator to lose weight.

Persistence doesn't equal meanness, but there are some who have posted remarks that lead me to think they would be less than patient with this patient population. To say I am prejudiced is just laughable; there are indeed some patients that really bother me, but overweight people do not.

mouse, the option of letting things lie would only be if all other measures have been tried and rejected. I don't think it's much different from working with people with addiction disorders. Some will get well on their own, some will get well with varying degrees of health, and some won't get well no matter what you do--they're just not ready.

I'm just very suspicious of people who post hurtful remarks and other detritus about overweight patients, then turn around and say they feel they could provide compassionate care. I don't see them as lowly creatures; I see them as people who for whatever reason are obese and are looking for help. The pts who come in for RNY--I consider them very brave. That surgery is life changing and quite demanding in terms of life-style changes.

I think it's important to ask the pt why he thinks he's gotten overweight. Ask the pt if anything has worked in the past; if so, what. It's such a mixture of medical and psychological issues, so definitely get psych involved.

Perhaps it was the initial tone that made it hard for me to express appropriately how I felt. In any case, I enjoyed discussing this with you, anon-y-mouse.

Please read MissMuffet's WONDERFUL response to what I was asking. Thanks, MM. I think the "you'd be doing it for my sake / children's sake / etc." could theoretically work really well. I am quite a proactive person, and I want to instill that in patients. I am very much a "what can we do, now that all the damage has been done?"-type of person. Given that these people are already super overweight, how can one convince them that they CAN get slimmer... that their burden *isn't* insurmountable? I am very interested in these psychological approaches. Thanks for the contributions.

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[SuperTrooper]

Not saying anything else, since this thread has clearly outlived any limited utility it once had, but...

You've clearly never been in any of the many nursing homes I've worked in.

clearly

You show me a 400 pound eighty-year-old and I'll buy you as much maple syrup as you can chug.

 

[MissMuffet]

Now you've made MY day, anonymouse! =] Good luck, and if you find the perfect answer to all of them, well, share the wealth!

 

[SuperTrooper]

To say I am prejudiced is just laughable; there are indeed some patients that really bother me, but overweight people do not.

I'm not saying overweight people bother you. I'm suggesting that the way you say you'd deal with overweight people is different from the way you'd deal with other people having non-weight related workable situations. Specifically if the therapy/treatment isn't successful or runs into difficulty.

 

[SuperTrooper]

 

[MollyMalone]

clearly

You show me a 400 pound eighty-year-old and I'll buy you as much maple syrup as you can chug.

Ewwww, no thanks. But, seriously, while you're right in that you generally don't see the really hugely gilbertgrapian 500+ lb. people, I have seen the 300-400 pounders. Then again, obesity is practically an art form here in WI, so maybe that explains it.

 

[SuperTrooper]

Then again, obesity is practically an art form here in WI, so maybe that explains it.

Wisconsin cheese curds.

 

[WestcoastMedicine]

I have worked in the past for a medical transport company and this is a big issue. Although there are not that many patients we encounter over 500 lbs, when they are encountered special equipment is needed. I have seen a backboard snap due to the weight of a patient and also a normal stretcher break due to the weight of the patient. In addition to the sheer weight, actually raising the rails on the side of the cot can be an issue because these patients usually are wider than the stretcher. In this case it is not only for the patients dignity to have a wider stretcher, but also for their safety as without them, they are not being transported safely in the ambulance. Just my .02

 

[docB]

To show how this issue is creeping into pop culture I note this item from The Onion:
http://www.theonion.com/content/node/47230
Now I don't think that this is funny (I usually love The Onion but this was off base). I find it interesting that the general public is becoming aware of this issue and is forming opinions. We all know that when left to it's own devices the general public led by the internet will usually form the wrong opinion.

 

[MustafaMond]

I have worked in the past for a medical transport company and this is a big issue. Although there are not that many patients we encounter over 500 lbs, when they are encountered special equipment is needed. I have seen a backboard snap due to the weight of a patient and also a normal stretcher break due to the weight of the patient. In addition to the sheer weight, actually raising the rails on the side of the cot can be an issue because these patients usually are wider than the stretcher. In this case it is not only for the patients dignity to have a wider stretcher, but also for their safety as without them, they are not being transported safely in the ambulance. Just my .02

Yeah...I've seen double-wide stretchers come out for the 500 lbs. + guys
Usually the standard pt. lifting crane won't lift that much either..
Ultramorbid Obesity is epidemic nowadays

 

[docB]

Ultramorbid Obesity

That's a great term. It explains some of the extent of the problem. Did you coin that or did you hear it somewhere?

 

[MustafaMond]

I guess I made it up.
I use the prefix "Ultra" for a lot of things.

 

[murphy54]

I must say ..you have a good point of view

 

[docB]

So I got to see AMR's bariatric ambulance today. It's supposed to be able to handle 1700 lbs. The gurney is huge and impressive but it is manual. Not electric like some of the newer (expensive) Fernos. It has ramps to move the gurney in and out of the ambi and a winch to haul the gurney up into the rig. No cherry picker on the roof to get the pt out of their 4th floor walk up though. And as of yesterday the winch was broken.

 

[Chinorean]

On a related note,

Can morbidly obese people exercise? I don't see them being able to do jumping jacks or go jogging and to go on a diet would take a long, long time. So I thought, maybe they can do water exercises. What if there was a facility where obese people could do water aerobics while supported by a strong metal arm, so they can exercise without risking their health? The staff would be comprised of medical professionals (who will swear on the honor not to make any jokes about whales). Would that work?

 

[PsychEpathic]

I was once fat. Why was I fat? Because I ate lots of sugars, tons of fat, and I never excercised. Was I made fun of? Absolutely. Before I hit the 300 mark, I said to myself, "I am gonna get diabeties if I don't change my lifestyle." So I decided to lose weight by getting off my fat ass and exercising. In addition, I maintained a low sugar diet.

To people who reach >300 pounds, they have my sympathy, but they put themselves in that situation. It's just too bad that we (as a society) have become so fat and unhealthy. The morbidly obese cost society money that we don't have to be spending. It really is a matter of personal responsibility.

 

[PsychEpathic]

On a related note,

Can morbidly obese people exercise? I don't see them being able to do jumping jacks or go jogging and to go on a diet would take a long, long time. So I thought, maybe they can do water exercises. What if there was a facility where obese people could do water aerobics while supported by a strong metal arm, so they can exercise without risking their health? The staff would be comprised of medical professionals (who will swear on the honor not to make any jokes about whales). Would that work?

Wow. I don't want to laugh, but I can't help it.

 

[Chinorean]

Wow. I don't want to laugh, but I can't help it.

I know, the idea of a swimming pool full of fat people is kind of funny (I don't know where they'd get their swimsuits) but if you had really professional people around and a no-cameras rule...and if you could set up these clinics around the problem areas in America...

 

[PsychEpathic]

It's all fun and games now, but what happens when fat people become the majority! They will discriminate again the healthy people . Sorry...

 

[PsychEpathic]

I know, the idea of a swimming pool full of fat people is kind of funny (I don't know where they'd get their swimsuits) but if you had really professional people around and a no-cameras rule...and if you could set up these clinics around the problem areas in America...

They can swim au naturel. It's not like you can see anything anyway.

 

[docB]

On a related note,

Can morbidly obese people exercise? I don't see them being able to do jumping jacks or go jogging and to go on a diet would take a long, long time. So I thought, maybe they can do water exercises. What if there was a facility where obese people could do water aerobics while supported by a strong metal arm, so they can exercise without risking their health? The staff would be comprised of medical professionals (who will swear on the honor not to make any jokes about whales). Would that work?

I see 2 big downsides to your plan. #1 it would be very expensive and before everyone chimes in about the cost of diabetes and coronary disease and so on remember that in the US no one will pay for preventive care. #2 we're not dealing with people who have shown themselves to be highly motivated to inprove thier health in the first place. I suspect that a gym designated for the ultramorbidly obese will be empty most of the time.

 

[PsychEpathic]

I see 2 big downsides to your plan. #1 it would be very expensive and before everyone chimes in about the cost of diabetes and coronary disease and so on remember that in the US no one will pay for preventive care. #2 we're not dealing with people who have shown themselves to be highly motivated to inprove thier health in the first place. I suspect that a gym designated for the ultramorbidly obese will be empty most of the time.

On a serious note, these people would definitely benefit from gastric bypass surgery. I'm wondering if that's cheaper than diabeties and coronary disease treatments? But by the time someone reaches 400 pounds, they may already have diabeties. Well, as one who was once obese (from age 8 to 21 ) and is now of healthy weight, I can tell you that the idea of getting type-2 diabeties scared the hell out of me. I'm wondering what other people are thinking...

 

[THP]

On a related note,

Can morbidly obese people exercise? I don't see them being able to do jumping jacks or go jogging and to go on a diet would take a long, long time. So I thought, maybe they can do water exercises. What if there was a facility where obese people could do water aerobics while supported by a strong metal arm, so they can exercise without risking their health? The staff would be comprised of medical professionals (who will swear on the honor not to make any jokes about whales). Would that work?

Yeah. . . Sea World.

 

[casi]

I know, the idea of a swimming pool full of fat people is kind of funny (I don't know where they'd get their swimsuits) but if you had really professional people around and a no-cameras rule...and if you could set up these clinics around the problem areas in America...

http://www.loveyourpeaches.com/shop/category.asp?catid=26
I know it's in bad taste, but the swim suit question just reminded me of this site. I found it while I was looking for plus sized swim suits (yes, I'm a obese girl, no I didn't buy one of these, and no I would never consider wearing one!). I thought they were rather shocking and related to the topic of the thread.

On the note of the topic of this thread obesity is a huge issue. Many large people want to lose weight, but don't know how to go about it. My biggest issue is if I go walking around the block are the neighbors going to be pointing out how the fat girl is triyng to lose weight and is probably failing miserably? Hence the reason I bought a treadmill. Neighbors can't watch me work up a sweat or watch the fat jiggle when I decide to up the speed on the treadmill to a nice little 30 second sprint. Now I just have to use the treadmill on a regular basis...

 

[PsychEpathic]

http://www.loveyourpeaches.com/shop/category.asp?catid=26
I know it's in bad taste, but the swim suit question just reminded me of this site. I found it while I was looking for plus sized swim suits (yes, I'm a obese girl, no I didn't buy one of these, and no I would never consider wearing one!). I thought they were rather shocking and related to the topic of the thread.

Wow, the only thing I envy about those women is their lack of shame!

 

[dawg44]

To all of those people that love to quote statistics touting socialized medicine get this we are the fattest country in the world. ONE out of THREE people are obese. If you consider that, there is no doubt we have the greatest healthcare in the world. Look at what we are given to work with, no wonder our stats aren't as good as in healthcare meccas like the UK and Canada.

 

[PsychEpathic]

To all of those people that love to quote statistics touting socialized medicine get this we are the fattest country in the world. ONE out of THREE people are obese. If you consider that, there is no doubt we have the greatest healthcare in the world. Look at what we are given to work with, no wonder our stats aren't as good as in healthcare meccas like the UK and Canada.

I don't understand your post...

 

[Wallachia]

To all of those people that love to quote statistics touting socialized medicine get this we are the fattest country in the world. ONE out of THREE people are obese. If you consider that, there is no doubt we have the greatest healthcare in the world. Look at what we are given to work with, no wonder our stats aren't as good as in healthcare meccas like the UK and Canada.

never thought of it that way; good point

i wonder if the medical outsourcers are prepared to deal with American size

 

[SuperTrooper]

Wow. I don't want to laugh, but I can't help it.

oh man, I just spent like two minutes laughing uncontrollably. I can't believe somebody bumped up this thread.

 

[SuperTrooper]

On a related note: check out this story. Apparently, they haven't built a special helicopter yet for fatties. Outrageous!

600 lb. Woman Survives Getting Thrown Through Sunroof

TOWN N COUNTRY, FL -- A woman is in stable condition after being ejected through the sunroof of her SUV during an accident.

Thirty-seven-year-old Ruth Matthews told paramedics that another vehicle cut her off in traffic, and she took evasive action to avoid a crash. Her Isuzu Amigo rolled over and she was thrown through the sunroof and onto the roadway. Investigators say she was not wearing her seat belt.

Paramedics initially tried to fly Matthews to Tampa General Hospital, but her weight, estimated at 600 pounds, made it impossible. Emergency crews were able to transport her to St. Joseph’s Hospital, where she is listed in stable condition.

Authorities are continuing their investigation.

http://www.firstcoastnews.com/news/strange/news-article.aspx?storyid=60096

 

[THP]

On a related note: check out this story. Apparently, they haven't built a special helicopter yet for fatties. Outrageous!

600 lb. Woman Survives Getting Thrown Through Sunroof

TOWN N COUNTRY, FL -- A woman is in stable condition after being ejected through the sunroof of her SUV during an accident.

Thirty-seven-year-old Ruth Matthews told paramedics that another vehicle cut her off in traffic, and she took evasive action to avoid a crash. Her Isuzu Amigo rolled over and she was thrown through the sunroof and onto the roadway. Investigators say she was not wearing her seat belt.

Paramedics initially tried to fly Matthews to Tampa General Hospital, but her weight, estimated at 600 pounds, made it impossible. Emergency crews were able to transport her to St. Joseph’s Hospital, where she is listed in stable condition.

Authorities are continuing their investigation.

http://www.firstcoastnews.com/news/strange/news-article.aspx?storyid=60096

Why is a 600 pound woman driving an Amigo? She probably weighed as much as the car.

 

[SuperTrooper]

Why is a 600 pound woman driving an Amigo? She probably weighed as much as the car.

Isuzu had a good marketing ploy when they first brought out the Amigo: you got a free ham sandwich with every test drive.

 

[PsychEpathic]

Isuzu had a good marketing ploy when they first brought out the Amigo: you got a free ham sandwich with every test drive.

.

 

[docB]

oh man, I just spent like two minutes laughing uncontrollably. I can't believe somebody bumped up this thread.

I bumped it after I got to actually check out that ambulance that inspired it. It was like seeing a technological achievement and tribute to problem solving on one hand and like paying homage to a mobile temple to the decay of American society and self indulgence on the other. It's really more than an ambulance. It's a metaphore for everything that's best and worst about this country.

I know that sounds kind of contrived but really. We've all become so disgustingly obese and have so little self control that we've maxed out normal ambulances. But as Americans, someone rose to the challenge and built this ambulance to solve the problem. We're clearly going to go down swinging.

 

[PsychEpathic]

I bumped it after I got to actually check out that ambulance that inspired it. It was like seeing a technological achievement and tribute to problem solving on one hand and like paying homage to a mobile temple to the decay of American society and self indulgence on the other. It's really more than an ambulance. It's a metaphore for everything that's best and worst about this country.

I know that sounds kind of contrived but really. We've all become so disgustingly obese and have so little self control that we've maxed out normal ambulances. But as Americans, someone rose to the challenge and built this ambulance to solve the problem. We're clearly going to go down swinging.

Damn, your replies are hilarious!

 

[SuperTrooper]

Damn, your replies are hilarious!

Yeah, that was pretty funny.

 

[SuperTrooper]

...that we've maxed out normal ambulances.

And helicopters too!

 

[8744]

Forget about the ambulances, how about the A-frame cranes they have to move morbidly obese patients? I excrete you not. The patient is strapped into a sling, lifted, and the bed is rolled away.

That's how they move Shamu at Sea World.

I once had to put a femoral line in a 600 pound woman. We tried tape to strap her pannus out of the way but it was too heavy. I then had two nurses haul her gut out of the way using a bed-sheet as a sling.

The cheese and gunk down there was amazing and probably the only time in my medical career I've felt like blowing chunks.

(We couldn't get an IJ becasue the patient couldn't tolerate being supine and a subclavicular line was out of the question because of body habitus.)

 

[docB]

Forget about the ambulances, how about the A-frame cranes they have to move morbidly obese patients? I excrete you not. The patient is strapped into a sling, lifted, and the bed is rolled away.

That's how they move Shamu at Sea World.

I once had to put a femoral line in a 600 pound woman. We tried tape to strap her pannus out of the way but it was too heavy. I then had two nurses haul her gut out of the way using a bed-sheet as a sling.

The cheese and gunk down there was amazing and probably the only time in my medical career I've felt like blowing chunks.

(We couldn't get an IJ becasue the patient couldn't tolerate being supine and a subclavicular line was out of the question because of body habitus.)

That's a tough situation. Sounds like a godd opportunity to wind up losing the line in all the flab. I had an obese gorked out nursing home patient once who came to the ER for "Fever- source unknown." Long story short I found a femoral line tucked up in there that no one knew about. God knows how long. Source found.

 

[SuperTrooper]

That's a tough situation. Sounds like a godd opportunity to wind up losing the line in all the flab. I had an obese gorked out nursing home patient once who came to the ER for "Fever- source unknown." Long story short I found a femoral line tucked up in there that no one knew about. God knows how long. Source found.

That's ridiculous.

 

[docB]

Yet not unheard of.

 

[8744]

That's ridiculous.

Um, I believe the correct SDN spelling is "rediculous."

But DocB's story is entirely plausible, especially if the patient had had a prior admission and especially if she came through the Emergency Department where they are more inlcined to put in femoral lines (because they are easier then central lines and any bleeding can be controlled with direct pressure).

On discharge you usually write an order to "D/C all lines" but that doesn't mean it always gets done. Especially on a morbidly obese patient who is being discharged when a nurse comes on shift who doesn't know the patient and the EMTs are waiting in the hallway to take the patient home after her lengthy and highly annoying hospital stay.

 

[8744]

I mean seriously. I think some of you have never really been up close and personal with people in the quarter-to-half-ton range. There is a lot of real-estate there and not everybody is willing to wade through adipose tissue to do a good physical exam like DocB did.

Do you really want to heft a seventy-five pound breat out of the way to listen to the apex of the heart?

 

[SuperTrooper]

Um, I believe the correct SDN spelling is "rediculous."

But DocB's story is entirely plausible, especially if the patient had had a prior admission and especially if she came through the Emergency Department where they are more inlcined to put in femoral lines (because they are easier then central lines and any bleeding can be controlled with direct pressure).

On discharge you usually write an order to "D/C all lines" but that doesn't mean it always gets done. Especially on a morbidly obese patient who is being discharged when a nurse comes on shift who doesn't know the patient and the EMTs are waiting in the hallway to take the patient home after her lengthy and highly annoying hospital stay.

Whoa! I never said DocB's femoral line story wasn't true; in fact I believe it 100%. I just think it's ridiculous, you know, that people are so fat these days, that something like a femoral line would go unnoticed by discharge staff and patient alike.

 

[8744]

Whoa! I never said DocB's femoral line story wasn't true; in fact I believe it 100%. I just think it's ridiculous, you know, that people are so fat these days, that something like a femoral line would go unnoticed by discharge staff and patient alike.

My apologies.

 

[PsychEpathic]

So I went to see my doctor today, and I saw a man of about 450 pounds in a wheel chair. As I waited in line to check in, an odor, a combination of feet, rotten cheese, and **** began permeating through the waiting area. The smell, needless to say, came from the 450 pound man. I was so disgusted that I started to gag . I know this may sound mean, but how can doctors stand that smell?! It was so gross! If my odor was that offensive because of my weight, that would be enough motivation for me to lose weight. Oh well...

 

[SuperTrooper]

So I went to see my doctor today, and I saw a man of about 450 pounds in a wheel chair. As I waited in line to check in, an odor, a combination of feet, rotten cheese, and **** began permeating through the waiting area. The smell, needless to say, came from the 450 pound man. I was so disgusted that I started to gag . I know this may sound mean, but how can doctors stand that smell?! It was so gross! If my odor was that offensive because of my weight, that would be enough motivation for me to lose weight. Oh well...

When I have normal-sized people in my dental chair it makes a nice humming sound as I move the chair up, down, etc. But with overweight people it makes this "Kachug, kachug" sound like it's gonna explode any minute. I've recently been wondering if there's a weight limit for the brand of dental chair I use; and I've also been wondering if they've designed dental chairs for fat people.

 

[caroladybelle]

Why is a 600 pound woman driving an Amigo? She probably weighed as much as the car.

And how did she fit through the sunroof, to get thrown out?

 

[Buckeye(OH)]

And how did she fit through the sunroof, to get thrown out?

The roof and back of the amigo is canvas (ie its removable).


Its not a sunroof as one might think; which was my first thought.

 

[PsychEpathic]

When I have normal-sized people in my dental chair it makes a nice humming sound as I move the chair up, down, etc. But with overweight people it makes this "Kachug, kachug" sound like it's gonna explode any minute. I've recently been wondering if there's a weight limit for the brand of dental chair I use; and I've also been wondering if they've designed dental chairs for fat people.

Forget the noises, what about the damage that's being done to your leg .