Jahi McMath back in the news - Part 2

[DGayle]

I can't imagine ever describing anyone coming out of this surgery as happy and bubbly. Mr. Sparkles was groggy and miserable and in extreme discomfort, even though he was tanked up on pain meds. Just this past Sunday, in fact, completely out of the blue, he started talking about how painful the recovery was. Even though the family's changed their tune now, describing her like that immediately post-surgery has to be blatant lie, as if to say "look what how vibrant and full of life she was and how the lack of care killed her!"

UPPP is also considered last-ditch surgery when other treatments have failed and it's not a cure-all. Mr. Sparkles (who's not obese) still needs his CPAP and the settings are cranked up. He does say it's been a big help though.

I also think she wasn't bright and bubbly. Groggy and hungry, maybe, but now vibrant and joking like nothing had happened.

[DGayle]

I agree. I've seen a lot of people complain that it's discrimination that they are asked to lose weight before surgery, not realizing that it is for their safety! Obese people absolutely deserve medical treatment, but there are real risks to obesity and surgery is much more dangerous for the obese.

There was a livejournal group that used to keep track of "fatphobic" doctors that was mostly doctors who dared suggest losing weight. If medical problems are probably caused by weight, it's bad medicine to keep quiet about it to not offend a patient, just like drinking or smoking. Change isn't easy, but it sometimes needs to be done, and if a patient wants to ignore the advice, at least they were told.

[DGayle]

Pushing a dead car is pushing a dead car. If you really believe that she is in any way alive just because decomposition is being delayed by artificially forcing her body through any functions (my feet pushing a car is artificial too), then you should start arguing that the death certificate should be revoked, the hospital should pay, and the family should get SSDI for her. If the litmus for death is the body is undeniably decaying even on machine support, what is to stop other people from demanding the machines because admitting death means losing some benefits?

[Trynn]

But did Jahi have a medical condition hat made losing weight impossible or near enough?

If my relatives are any indication, People with sleep apnea are usually super tired. I wouldn't be surprised at all of exercise was near impossible for Jahi to exercise much.

I do agree that being fat can cause medical issues, but the things I have been told are said to patients who are overweight... It's just like... Obesity does not cause everything.

[ghost]

No. Based on what has been released, it appears that Bobbi Kristina has a brain injury/damage due to not getting oxygen. She is in a medically induced coma and still has some brain function (to what level we don't really know but supposedly she had seizures when they tried to wake her up nor do we know her chances of a meaningful recovery). She is not brain dead.

Thank you.

[Firiel]

But did Jahi have a medical condition hat made losing weight impossible or near enough?

If my relatives are any indication, People with sleep apnea are usually super tired. I wouldn't be surprised at all of exercise was near impossible for Jahi to exercise much.

I do agree that being fat can cause medical issues, but the things I have been told are said to patients who are overweight... It's just like... Obesity does not cause everything.

Yes, sleep apnea can cause a bad cycle. Sleep apnea will almost always improve with weight loss, but it won't necessarily go away. The problem is that sleep apnea keeps you from getting a good night's rest. When you are tired, you secrete LESS leptin (the hormone that tells you that you are full) and MORE ghrelin (the hormone that tells you that you are hungry). So when you are tired from sleep apnea, you are more likely to gain weight because you are hungrier (in addition to being too fatigued to be active, as you pointed out). As you gain weight, the sleep apnea gets worse which makes it easier for you to gain MORE weight.

[DGayle]

I've questioned before why it's not okay to starve a kid to death, but it's fine to overfeed a kid to death.

[Alice_Fraggle]

My directives are donate any organs that can be, and then ship me off to a medical school. Doctoral and nursing students need to work on cadavers to learn. Better do that learning on dead bodies than alive bodies.

I loved Body Worlds and went 2 times. My kids were fascinated by it. If I don't go to a medical school to be sliced up by students who need to learn, then send me to Body Worlds. It's a better use of our bodies than tossing us in an incinerator or a bod in the ground.

I loved Body Worlds too - well, except for the "Angel woman" - that's just playing with a dead body - but the rest was fascinating!

Did you know you can donate your body to The Body Farm? That's what I'm going to do, and if they don't want me then cremate me. :)

[Chowder Head]

http://www.sciencebasedmedicine.org/wha ... ain-death/

[DGayle]

Yup. Dead as a doornail. I honestly believe her family is doing this hoping for a big payout. It's really unfortunate that they're going to force a judge into a position most judges probably won't feel qualified to be in, to make a judgement that most judges would hate to make. I fear a judge might err on the side of being conservative, say that if the family says she's alive, then that's what matters, and opening the doors for other parents of dead kids to delay decomposition for the sake of a huge payout.

[Blahblah]

Yup. Dead as a doornail. I honestly believe her family is doing this hoping for a big payout. It's really unfortunate that they're going to force a judge into a position most judges probably won't feel qualified to be in, to make a judgement that most judges would hate to make. I fear a judge might err on the side of being conservative, say that if the family says she's alive, then that's what matters, and opening the doors for other parents of dead kids to delay decomposition for the sake of a huge payout.

There's a whole new industry right there - warehouses of dead-not-dead corpses hooked up to machines while the courts figure out how much their families decisions to switch them off can be bought for.

[Burris]

But did Jahi have a medical condition hat made losing weight impossible or near enough?

If my relatives are any indication, People with sleep apnea are usually super tired. I wouldn't be surprised at all of exercise was near impossible for Jahi to exercise much.

I do agree that being fat can cause medical issues, but the things I have been told are said to patients who are overweight... It's just like... Obesity does not cause everything.

If someone of average weight comes in with a complaint, most doctors will investigate it. If someone overweight comes in, then it seems that medical laziness takes over and the entire "examination" invariably boils down to losing weight - whether the item has a damned thing to do with weight or not.

(My brother is an adult with sleep apnea and he is underweight.)

[Maggie Mae]

If someone of average weight comes in with a complaint, most doctors will investigate it. If someone overweight comes in, then it seems that medical laziness takes over and the entire "examination" invariably boils down to losing weight - whether the item has a damned thing to do with weight or not.

(My brother is an adult with sleep apnea and he is underweight.)

I think some of that isn't necessarily "medical laziness" but trying the most obvious treatment first. IMO, doctors SHOULD be trying non invasive interventions - changing diet, physical therapy, etc - before prescribing medicine or surgery. If a morbidly obese person presents with some sort of pain in the joint, of course the doctor will ask that they try to lose weight first and see if the pain alleviates on their own. If a person with a BMI low enough that the additional weight wouldn't cause problems comes in with joint pain, the doctor starts a different place. It's not wrong for the doctor to prescribe the less invasive method of alleviating pain, which for many people is weight loss. Less weight to haul around = more energy, less pressure on joints and injuries.

[shedemei]

I think some of that isn't necessarily "medical laziness" but trying the most obvious treatment first. IMO, doctors SHOULD be trying non invasive interventions - changing diet, physical therapy, etc - before prescribing medicine or surgery. If a morbidly obese person presents with some sort of pain in the joint, of course the doctor will ask that they try to lose weight first and see if the pain alleviates on their own. If a person with a BMI low enough that the additional weight wouldn't cause problems comes in with joint pain, the doctor starts a different place. It's not wrong for the doctor to prescribe the less invasive method of alleviating pain, which for many people is weight loss. Less weight to haul around = more energy, less pressure on joints and injuries.

That's good in theory, but if a person is morbidly obese they're not going to be losing weight fast enough—if they manage to lose any at all— to make it feasible for diagnosis. Meanwhile, they'll be in pain. Why not be practical and also move on to step 2? "Lose weight, next patient!" is lazy.

I do agree that physical therapy should be first. PTs are often much better than MDs at diagnosing and treating musculoskeletal problems, at least in my BTDT experience.

Note: I'm generally critical of the fat acceptance movement, so I'm not just "making excuses" or whatever.

[DGayle]

Shedemei, what would you suggest then, if what's practical is to skip the most obvious course first? Oftentimes, even 15 pounds off for a morbidly obese person can have drastic positive effects, and most morbidly obese people are overeating (most, I know some people have medical issues with metabolism, or are on meds that pack on pounds), and a dietary change helps it come off fast. Even when it comes to lapband and gastric bypass, a lot of people have to lose weight. So skipping weight loss and going to surgery or whatever still usually means losing weight without surgery. It is NOT lazy for doctors to tell patients that they need to lose weight before going under the knife. If a doctor didn't, and went right for something invasive and the person died, the doctor would be sued out of practice for skipping the least-invasive method first.

[shedemei]

Shedemei, what would you suggest then, if what's practical is to skip the most obvious course first? Oftentimes, even 15 pounds off for a morbidly obese person can have drastic positive effects, and most morbidly obese people are overeating (most, I know some people have medical issues with metabolism, or are on meds that pack on pounds), and a dietary change helps it come off fast. Even when it comes to lapband and gastric bypass, a lot of people have to lose weight. So skipping weight loss and going to surgery or whatever still usually means losing weight without surgery. It is NOT lazy for doctors to tell patients that they need to lose weight before going under the knife. If a doctor didn't, and went right for something invasive and the person died, the doctor would be sued out of practice for skipping the least-invasive method first.

Maybe "lazy" is the wrong word. It's downright irresponsible, dismissive, and mean to say, "well you're just fat, fatty, and I'm not doing anything for you until you lose weight." I'm also not saying they should skip anything; I am saying that they should suggest losing weight and take the next diagnostic step anyway instead of waiting. You know, the same damn thing they'd do if a normal weight person came in.

I lived with chronic pain for seven years, during which time I was screened for an aneurysm, got multiple MRIs, was given muscle relaxants, and a few other things. It wasn't until I found a competent physical therapist that I was finally diagnosed as having a twisted pelvis. Weight had nothing to do with that, at all. If I'd been obese and the doctor told me to lose weight without offering other options, I'd have been living with chronic pain for another four years, and probably the rest of my life.

BTW, trying to lose weight in my situation would have made the problem more difficult to solve because it got worse over time and exercise aggravated the problem. In fact, my initial symptom was exercise induced headaches so that was something I was afraid of doing.

[Burris]

I think some of that isn't necessarily "medical laziness" but trying the most obvious treatment first. IMO, doctors SHOULD be trying non invasive interventions - changing diet, physical therapy, etc - before prescribing medicine or surgery. If a morbidly obese person presents with some sort of pain in the joint, of course the doctor will ask that they try to lose weight first and see if the pain alleviates on their own. If a person with a BMI low enough that the additional weight wouldn't cause problems comes in with joint pain, the doctor starts a different place. It's not wrong for the doctor to prescribe the less invasive method of alleviating pain, which for many people is weight loss. Less weight to haul around = more energy, less pressure on joints and injuries.

Telling a fat person to lose weight isn't exactly rocket science. When an MD does it, without any real effort to address other issues that may or may not be related to the weight - and especially pain that makes it difficult to exercise, as well as potential psychological problems - the doctor is definitely being lazy and is being paid to basically perform the "service" of a school bully.

I find it interesting that people with bulimia are treated psychologically and people who are obese are treated as if excess weight is the result of a character flaw. If a fat person wants morality lessons on gluttony, she goes to a preacher, not a doctor.

[DaffyDill]

Telling a fat person to lose weight isn't exactly rocket science. When an MD does it, without any real effort to address other issues that may or may not be related to the weight - and especially pain that makes it difficult to exercise, as well as potential psychological problems - the doctor is definitely being lazy and is being paid to basically perform the "service" of a school bully.

I find it interesting that people with bulimia are treated psychologically and people who are obese are treated as if excess weight is the result of a character flaw. If a fat person wants morality lessons on gluttony, she goes to a preacher, not a doctor.

Re the bolded: I watched a series of documentaries which followed several people through the process they needed to have a gastric bypass (one each week), and culminated in a followup after a few months on their progress. I thought it was interesting that the doctor/specialist they all saw, recommended several lose weight before the operation to lessen the risk, and also sent each patient to a psychiatrist/psychologist (can't recall which), who had the final say on whether the bypass could go ahead. Without the go-ahead from the psych., no operation. Some patients were refused the bypass until several sessions with the psych to assist them with their eating disorder (if there was one), their depression (if there was any) etc.

I was surprised, but thought it was an excellent way to treat not only the bodies of these obese people, but also their minds, which may have exacerbated the over-eating and helped brought on the obesity. They also were assisted by a nutritionist who over time taught them healthy eating habits, meal plans, how to cook vegetables they had never even tried before.

[DGayle]

Shed, I thought you were talking about skipping that step altogether.

[CaptainFunderpants]

Going to chime in here: First and foremost you don't need to exercise at all to lose weight; simply eat fewer calories than you burn.

Second of all: No disease not controlled by the brain causes someone to be morbidly obese. A severe thyroid disorder maybe adds 20lbs at most; PCOS doesn't break the laws of thermodynamics -calories in, calories out still stands. In terms of drugs causing weight gain: Yeah, they can make you puffy, but if you're on them long term help with your diet is supposed to be provided by your med team. If it truly is the drugs that made you fat, within three weeks of being off of them you'll drop either all of the weight you gained, or at least 20lbs; it comes off in a hurry.

Third of all: the difference between a good metabolism and a bad one is 300 calories; that's roughly one packet of M&Ms.

This poor, poor abused child.

[anjulibai]

Most doctors, in my experience, won't just say "lose the weight, or else I won't do anything". They'll say "we'll, let's try this, but you should also try losing the weight because that is probably exacerbating issues".

When I had back problems, my doctor did a lot for me. But she also told me that the extra weight I was carrying was likely making things worse, if not causing some of my pain. She also told me that exercise would not only lessen the weight, it would strengthen my back and abdominal muscles, which in turn could help with the pain. She also said eating better, in addition to helping me lose weight, would give me energy to exercise and I'd feel better form doing that.

So, the process of losing weight, exercise and eating better, had multiple health benefits. If you are overweight, you don't eat well or exercise, and you are having any sort of health problem, the doctor is going to recommend losing weight because doing so will help with many things.

I remember when an old friend was having issues with his knee. He was only in his late 20s, but he had been morbidly obese since middle school. The doctor did a lot for my friend, knee braces, physical therapy, X-rays, MRIs, etc. Ultimately, it was my friend's weight that was the cause of the problem. When my friend lost weight, his knee got better.

We have to remember, doctors are trained to rule things out. They look at the simplest and likeliest explanation first, before going on to more complex diagnoses. That's deductive reasoning, and they have to do it, because that's just how medicine works.

Often the simplest explanation to a lot of problems is that the person is overweight. So course, they have to suggest you lose weight, otherwise they can never rule out that the weight is the problem.

It's frustrating at times, but it is what it is. Most doctors, will do more for you, because they know it takes a lot to lose weight. But they would be derelict of their duties if they did not bring it up and recommend it.

[Rachel333]

I find it interesting that people with bulimia are treated psychologically and people who are obese are treated as if excess weight is the result of a character flaw. If a fat person wants morality lessons on gluttony, she goes to a preacher, not a doctor.

I do think there's some truth to this, but it's extremely common for people with bulimia or anorexia to be told they need to just choose to stop and for it to be seen as a character flaw (bulimia especially; I think people tend to be more sympathetic to anorexics, sadly enough). I think most people, doctors included, just aren't that familiar with eating disorders. Actual mental health professionals, especially eating disorder specialists, tend to take the psychological issues behind overeating very seriously.

Actually, I think people often focus too much on the psychological nature of anorexia and bulimia. It's often the medical aspect that needs to be addressed first; you don't get a whole lot out of therapy when you're starved and medically unstable, and it's extremely difficult to get out of that by yourself.

[Burris]

Second of all: No disease not controlled by the brain causes someone to be morbidly obese.

As far as I know, no organic disease of the brain - a detectable physical anomaly - causes people to starve themselves, either.

The double-standard is bullshit.

[Maggie Mae]

There actually is abnormal brain activity that is recorded in people anorexic and with BDD. I read a story about the study that was published earlier this month.

There are also differences in obese peoples brains as well. And high levels of impulsive behavior, addiction, and brain inflammation. Doctors should be treating the whole person, not just their weight. But they also shouldn't put a person through unnecessary surgery. If the patient is non-compliant when it comes to the easy stuff - following a diet plan, participating in physical therapy and following through with prescribed activities and exercise - how can a doctor trust that his patient will follow after surgery care plans? Why should he prescribe pain medication that has side effects and will allow the patient to build up tolerance when the majority of people experience huge gains in quality of life by simply changing their diet and adding in some movement?

[Burris]

There actually is abnormal brain activity that is recorded in people anorexic and with BDD. I read a story about the study that was published earlier this month.

There are also differences in obese peoples brains as well. And high levels of impulsive behavior, addiction, and brain inflammation.

Didn't know that. I'm not surprised, however, to learn that if brain anomalies exist in people with anorexia, they also exist in people who are morbidly obese.

No one wants to be so heavy they can't move without aid, or that they're suffering major joint pain from the excess carriage. People can choose to eat one thing as opposed to another - but fatty food is actually somehow more satisfying. At least to some.

I don't have a problem with weight loss initiatives: The wait list for them is grossly long here, though.

See, not only am I overweight, but I know damned well why I eat.

My husband, on the other hand...he is, for his height, bigger than me by quite a bit. I don't mean that as an insult. I love him. And his height/weight ratio scares the hell out of me.

The thing I can't figure out, however, is why he eats. He doesn't quite know himself. He's a poor candidate for gastric bypass surgery, however, because while I'm sure he'd comply with the diet plan - especially since I'm the one cooking, and if I have to eat leafy green shit, he does, too - he is physically deformed by a genetic condition. The deformities and the weight and the trach leave him feeling tied down - and until Weight Wise gets down to him on their list, I'm not entirely sure what to do about it.

It isn't how much we eat, since we eat twice a day; it's what we eat - and we know it. But knowing a thing and doing something about it aren't always the same - especially when you're not quite sure where the line is between enough and too much.

I expect my case would be harder to treat than his, however: I eat to feel better, whereas he seems to eat because he never feels full.

Doctors should be treating the whole person, not just their weight. But they also shouldn't put a person through unnecessary surgery. If the patient is non-compliant when it comes to the easy stuff - following a diet plan, participating in physical therapy and following through with prescribed activities and exercise - how can a doctor trust that his patient will follow after surgery care plans?

Yeah, but when "physiotherapy" is a twice-weekly 30-minute exercise in agony as performed by a student (because most PTs are scared to treat someone with my husband's genetic condition), that's not exactly optimal.

I'm not exaggerating: My husband's lungs failed two and a half years ago and he has been on a vent ever since. The only lung specialist who would consent to treat someone with his constellation of problems is an arrogant go-getter who would sooner burn herself out in a quest for martyrdom than actually treat her patients. When my husband said no to her "suggestion" of gastric bypass surgery, opting for the weight-loss regimen GP patients have to go through first instead, she decided not to see him or return his calls for the next two fucking years!

Every good he gained in hospital he lost again, and then some.

If the PTs don't know how to treat him so his bones won't break, I certainly don't.

And while I'm willing to shoulder some of the blame for this, that heinous bitch should have her medical license revoked before her arrogance or poor impulse control kills someone.

It's outright negligence, and yet finding another lung specialist who will theoretically take him on is going to take us out of this city - or out of this province.

Why should he prescribe pain medication that has side effects and will allow the patient to build up tolerance when the majority of people experience huge gains in quality of life by simply changing their diet and adding in some movement?

Well, my left side from shoulder to heel is held together by rods, screws, plates, and what looks suspiciously like chicken wire. There are days I absolutely don't want to move. But when a chunk of metal starts moving, or I get cold enough for the rods to chill, that is truly when the "fun" starts.

And my husband has had over two hundred breaks in his bones across his 41 years - so if he doesn't want to move - and he doesn't, when he's in pain, which is pretty much always now - there isn't a damned thing I can do about it.

Of the worst experiences in my life, nothing any civilized person can do will ever tie for first (oh please God never again, this time),

But this? This managed to tie for second.

'Oh my goddd, fat acceptance is sooo horrible' - yeah; fucking bite my big fat ass.