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Let’s tell it like it is folks.

November 19, 2012

Alright, I’m only going to say it once.  Some people are fat.  I know it’s not PC to say so but you know who you are.  Now I love everyone who reads this blog unconditionally and I don’t personally care what you look like but, from a medical point of view, being fat is just dangerous.   I’m saying this because I care about you people!  Everything we do in medicine is either more difficult or more dangerous if you are severely overweight.  I’m not talking 10 or 12 pounds over, by the way.  I’m talking about those who’s life expectancy is actually significantly shorter just because of how much they weigh.

We all know that overweight people use more medical resources.  They need medications for blood pressure and blood sugar, they get gastric bypass or gastric banding procedures (more about this in another post), they need machines for sleep apnea, etc.  IVs are harder.  Imaging is harder and less accurate.  But did you know they/you are at increased risk of dying every time you step into a pre-op holding area?  Even light sedation is dangerous.  So much so that if you are coming in for, say, a colonoscopy, what would normally be a routine procedure with a little valium becomes a major operation with anesthesia.  Even a little sedation can make your breathing less effective, and you don’t have the oxygen reserves that other people do.  So your oxygen level goes down and it’s hard to get it to come back up.  Just last week I did sedation for a young woman for an endoscopy (where they look down into your stomach with a scope).  Healthy woman but very fat.  8 minute procedure.  Her oxygen saturation fell into the 50% range.  Folks, your heart can STOP BEATING at that level.  Hers didn’t thank goodness.

Or say you need your appendix out.  Nowadays everyone does it through a scope.  So you come in, your anesthesiologist gives you the stink eye, not because she doesn’t love you, she does, but because you’re likely to scare the living daylights out of her.  She has to put a tube down your throat and breathe for you while you’re asleep, and your weight makes that much more difficult and much more dangerous.  Then she has to breathe for you while the surgeons fill you belly up with carbon dioxide, taking up any space you lungs may have thought they had a lease on.  Then she has to wake you up, and make sure you’re really awake or you might not breathe well and then we’re really up a creek without a paddle.

I’m not saying any of this to guilt fat people out or make any one feel bad about themselves.  As all the posts in this blog, I write because you need to understand why medical people do what they do, and to realize the risks that we undertake for our patients every day.  Some more than others.

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