Saturday, April 01, 2006

Hospitals Overwhelmed with Morbidly Obese Patients

The Duke Rice Diet used to attract "morbidly obese" people back in the 70s. I was living in the town of Durham NC at the time while my ex attended medical school and training. I worked at Duke U, and while there, and while running my usual errands to grocery and PO I might run into Buddy Hackett, or the Kentucky Colonel ... or some equally huge, but not famous, people. Mostly men. I mean huge people, like 300, 400 lbs.

The Duke Diet could get the weight off and the BP down (a residence program), though it would come back. Buddy and the Colonel were regulars every summer.

Recently I went on a cruise and saw the same thing. An inordinate number of really obese people. I remember seeing one guy who had fallen asleep with his head in his plate about 3 in the afternoon-- of course there's a "plate" available on a cruise 24/7. Another managed to get into the hot tub, and all the water spilled out.

Sitting in the hot tub myself, later, the woman in there with me, from France timidly offered: "I didn't know Americans were fat. Are there so many this fat everywhere in the US? We don't see this, you know, on the television."

Well, evidentally we do. I'm sure you've gotten an inkling like I have that it's a growing issue. Southwest Airlines making obese people buy two seats. People you see around you. I hear things, too; you may as well. My friend's son is in medical school. His father, an internist, has gone from 6 figures 20 years ago, to barely making $40k because of the squeeze on physicians now (physicians who don't do procedures). (Yes, I know, you're crying your eyes out, but I maintain someone who trains for 10 yrs. post-grad should make more than a nail tech!!) My point? John Jr. has decided to go into Bariatric medicine.

Following in the wake of Southwest, other service providers are having to get their heads up out of the sand. A what's called "morbidly obese person" in a hospital - - or ambulance - - is not going to be a fluke any more. It's becoming ... frequent.

Las Vegas ambulance companies have had to redesign the ambulances, including installing hoists and bigger beds.

Last year a patient care director in a St. Louis hospital was seeing things she could no longer ignore, so she ran the numbers. That day about 1/3 of their 900 patients weighed 350 lbs. or more. She decided to go back and see it that was a fluke. Nope. Some days half the patients were obeses, and 500 lbs. wasn't unusual.

Now, I don't see a lot of people weighing 500 lbs. In fact I may never have. And the fact that hospitals do says what it says (I'm coming to WELLNESS next). Obese people usually have a myriad of health problems -- that's why your doctor wants you to lose -- and they probably visit the hospital more often.

Now this hospital has formed a Bariatric Care Team to take the mountain to Muhammed. (Perhaps not the best analogy to use, either way.)

Now think for a moment of life in a hospital for a patient, and then picture this patient weighing 500 lbs. Normal supplies, equipment, training and personnel must be adjusted.

++The union says healthcare personnel are getting sprains and strains trying to lift obese patients.
++Do the gowns fit? Slippers? Blood pressure cuffs?
++Can they fit through the doors, in the chairs and on the bed?
++Can the ordinary stethoscope handle the layers of adipose tissue around the heart and lungs? Nope. New ones are being designed.
++What about the stretchers and wheelchairs?
++Longer needles for butt shots?
++Can a 500 lb. person go through the average CT scanner or MRI? Of course not.

The nurses' union which operates in 18 states (ATF Healthcare) is demanding new laws to force hospitals to buy equipment like portable hoists.

This hits home with me. My dad's mother was quite obese - over 300 lbs. and when, at the age of 89, she had a heartattack in her bed at home, the ER techs had to call for a hoist, such as they lift cattle with, to get her out of the bed and downstairs into the ambulance. The hospital had to order one too, and then the retirement home.

There are things you wouldn't think of, too. One hospital has installed lights at floor level, because a grossly obese body casts a shadow and they can't see the floor.

Grandmother had to have someone put her snow boots on for her, and had to use a long pair of cooking tongs to pick things up off the floor.

Beds are now going to accommodate 500, not 350. A nurse manager at Barnes-Jewish hospital said they'd had some -- SOME -- 650 pounders on the ward.
36" standard doors are going to become 48" or 52". Comodes must be anchored to the floor so they don't get ripped out of the wall. The longest syringes (4 1/2") are going to become longer.

The suppliers are working to meet the demand. Novation, LLC saw the trend start about 4-5 years ago and they now supply over 1000 items to hospitals for obese patients. (What about towels, and blankets??)

But there are things still not made ... like a body bag. It's the law it has to be leak-proof, and some patients were so large in one hospital, they wouldn't fit in the body bag.

Here are some links where you can read more:

Barnes-Jewish Hospital:
merican Hospital Association:
Novation LLC:
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Susan Dunn is an Indpendent Arbonne Consultant

Right now I'm reading A General Theory of Love, by Lewis, Amini and Lannon
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