Chest XRay With Morbid Obesity

When you look at a thousand chest x-rays, your mind trains you to see automatic outliers. I like to call this asymmetric lines of demarcation. Massive obesity affects the ability of your doctor to diagnose and treat you. When the xray doesn't penetrate. When the ultrasound doesn't penetrate. When the echo doesn't penetrate. When you can't get on the cath table or fit in the MRI or safely survive surgery. The ability of your doctor to evaluate and manage your illness is severely limited.

Sadly, often times the patient nor their insurance has the motivation nor the desire to intervene. Generally speaking, the morbidly obese, I'm talking hundreds of pounds overweight have limited medical resources available to them. In spite of most being on full disability with guaranteed life long government care, most have difficulty at some point or another in undergoing appropriate diagnosis and evaluation. They have all the health care taxes can buy. Yet, they have almost nothing. A lot of the evaluation process and accurate diagnosis becomes a guessing game who's outcome is based on the skill of the physicians.

I take care of many incredibly obese patients in a years time. 500 pounds. 600 pounds. The story is always the same. Skin infections. Heart failure. Life threatening obesity related respiratory failure. We can't scan them. We can't xray them. They are too heavy for the procedural tables. The cardiac echo machines can't find a decent picture of the heart. The x-ray machines can't bounce enough x-rays to get a good image. Medication doses are generally inappropriate. Their physical exam is generally very limited due to massive layers of tissue that hide blood vessels and auscultated sounds.

You treat them to the best of your ability. But you know, they will be back. Soon. Or perhaps they will die in their sleep. When they are on my service, all I can do is give them a band aid and hope they survive until the next admission.

It's quite sad. How do you help them? I mean REALLY help them? The hospital care is a band aid for their life threatening obesity. The resources for help are often limited. The home life is often self fulfilling. The ability to rehabilitate the mind is often limited. The motivation is often lacking.

Perhaps life threatening obesity is a chronic form of physical and mental suicide. Where I practice folks who are suicidal get admitted to psychiatric floors. Should life threatening obesity be treated any differently? Is there a difference between saying "I want to kill myself" and "I am killing myself?"

Whatever the answer, I know I am not the doctor for them. I am their band aide. Their needs are far greater than any one doctor or field of specialty. Or medical care for that matter.