Sunday, September 14, 2008

A Sobering Email

Good morning, friends! It was so good to hear from all of you the last time I posted. The book proposal is coming along (with the help of a good coach who helps keep me on task), but I wanted to share some info I got from my friend Rhonda, a radiologist in Florida. Rhonda and I went to grade school and junior high together and I just saw her when I was in Minnesota in August.

Anyway, she sent me an email in response to a blog I wrote over on Refuse to Regain and I wanted to post her observations here as well as RTR. I was completely unaware of how being overweight or obese can interfere with what we might think of as the most simple medical procedure: an x-ray.

Here's what Rhonda wrote:

“I am reading this blog on a short break at work, where I am reading CT (CAT) scans, MRI's and Ultrasound exams, and it struck me to let you all know one of the health benefits that your weight affords you.

“We all know and think about the decreased risk of diabetes, heart disease, stroke, etc., from weight loss, but one of the things that I see in my daily practice is how much harder it is to image someone who is significantly overweight. The bigger you are, the more x-rays it takes to penetrate your body and the fuzzier the pictures are (even a plain old chest x-ray can be suboptimal). The bigger you are, the more your own body fat throws artifact on a CT scan, making it difficult to see. Ultrasound is not good at penetrating fat, so there are a lot of things we can't see with it in large people.

“If you are big enough, you may not even physically fit into an MRI scanner and for many, important applications, the open configuration magnets (which are often a lower magnetic field strength) are not adequate. All of our CT tables and tables where we do angiograms have weight limits above which we can't move the table with the patient on it or risk the table collapsing. Never mind the risk to hurting the patient, the repair bills for those tables can run in the hundreds of thousands of dollars range, so we end up having to literally not perform studies on patients who are over the weight limit. Even mammograms, in very large patients, I have seen us have to take four overlapping images for just one view of one breast in order to be able to cover the tissue adequately (a standard mammo consists of a total of 4 films, 2 views each breast).

“Some would say that by not having tables large enough to accommodate the bigger patients (there are a few manufactures out there who offer them), we are being discriminatory to the obese. The problem is that these machines cost upwards of $1 million for MRI and CT scanners and the larger format scanners often times give markedly suboptimal exams for people with more normal body habitus.

“My point is that not only are you decreasing your risk of significant health problems by losing weight, if you do become ill (brain aneurysm, appendicitis, etc. -- things that don't care how much you weigh), the chances of us being able to use our high-tech gadgets to diagnose and treat you are markedly improved by your weight loss.”

I wrote back and asked her, “If you were to find a lump and doctors performed surgery, is the actual surgery more difficult through layers of fat and is recovery more difficult?”

She wrote back:

“Since I am not a surgeon, I don't have 100 percent knowledge of surgical complications, but I can tell you about my experience with angiograms.

“When we get someone who is significantly overweight (but not over the table limits), they are prone to an increase in several complications. First of all, they may be so big that we can't feel the femoral pulse in order to do the puncture. That means we may need to use ultrasound to identify the artery and guide puncture. The gel from the US MAY slightly increase the risk of getting an infection at the puncture site.

“Secondly, we may need to use a longer need to hit our target.

“Thirdly, once we get in the vessel, we then put a guide wire ( a wire that looks like a guitar string with a floppy end at the front and a stiff part in the middle and end) so that we can take the needle out and put our catheter (tube with holes in it) over the guide wire into the vessel. Much harder to get a catheter to follow a guide wire through several centimeters of layers of fat, rather than just a couple for normal sized people.

“When we are finished with the procedure, we remove the catheter and hold pressure on the artery to stop the bleeding: harder to hold in big people and this increases the risk of getting a hematoma (a big blood clot in the tissues). Even if you don't get a hematoma during the hold, one can develop in the hours following the procedure and is harder to diagnoses if it is buried amongst the fat. Also, our bigger patients tend to also have back pain, which makes it harder for them to lie flat in bed (which we require them to do post procedure in order to heal the site). So if they are squirming around because they are uncomfortable from their back, this increases the risk of them getting a hematoma.

“Regular surgery can be technically more difficult in big patients. I still remember a lecture from one of the teachers in med. school. The lecture was ostensibly about ovarian cancer (which affects the 4 "F's": female, forty, fertile, fat). Most of what I remember was slide after slide of the retractor devices this particular doc had designed to hold back the pannus of the patient to adequately access the surgical site. It can be harder to keep the surgical site clean, post-op, increasing the rates of infection.”

Thanks, Rhonda, for the great info.

4 comments:

  1. Glad to see you are still around - Thanks for this post. I have been told by some of my Doctor's that being overweight does make it harder for them to examine me. So that is another reason I am on my journey my health is and should be my #1 priority. Keep in touch we miss you.

    Mara
    http://24stepstogo.blogspot.com/

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  2. I never really thought about this aspect of being obese. I'm glad you put it in your blog. There really are so many drawbacks to being overweight, and this is another one that not too many people probably have thought of.

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  4. Its not just about a diet in my opinion exersize is equally important

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