June 19, 2019

"c-sections can be very dangerous through a foot of fat tissue."

Sentence from a comment by an obgyn on a NYT article, "When You’re Told You’re Too Fat to Get Pregnant/Does it make sense, medically or ethically, when fertility clinics refuse to treat prospective mothers they consider too large?"

43 comments:

Ann Althouse said...

I had the wrong link before. Thanks for the heads up. Fixed.

EDH said...

"c-sections can be very dangerous through a foot of fat tissue." Sentence from a comment by an obgyn...

Indeed, we have the video of that doctor at work.

Sheridan said...

Going under the knife to transition from male to female or vice versa is also medically dangerous. And yet, that practice occurs. Where are the medical ethicists on those events? The world now is "everything goes - no limits - no restraints". Sue the fertility clinics and get what you WANT!

rhhardin said...

Do you gain weight

Ken B said...

This just highlights the need for more training so obgyns can deal with a foot of fat. Why aren’t they trained properly now? The patriarchy. When obese men need c-sections then we'll see adequate training.

Ann Althouse said...

I'm interested in the problem of doing surgery through a very thick layer of fat. You don't hear much about it. The article is specifically about pregnancy, but what about other surgery? Are fat patients rejected?

I've known of cases of people who were considered to thin for surgery too — people who needed cancer removed but had to gain weight first.

Ken B said...

In England the obese are routinely denied operations until they lose weight.

Sheridan said...

I often wonder if the people who are pushing for Single-Payer/Medicare For All/Universal Health Care appreciate the reality that such a system would require both rationing and surgical restrictions of such care. If the government is in charge, would they prioritize artificial inseminations for obese women over kidney transplants for middle-age women? Gender transitioning over heart-valve replacements? Will only the young, diverse and woke "win"? How about the old, white people with money. Will their money be useless especially if the government prohibits any delivery of medical service outside the boundaries of the single-payer construct? I'm beginning to think that the imposition of socialism will not necessarily provoke civil conflict. It's the delivery or denial of medical treatment that will cause uprisings.

I Have Misplaced My Pants said...

Paging Dr. Kennedy!

Birkel said...

Wait, so the fat lady wants to implant a parasite inside herself?
What will the pro-abortion feminists think of next?

Eugenics, anybody?

wwww said...

"I'm interested in the problem of doing surgery through a very thick layer of fat."

All operations have risk. A woman comes into the ER with a ruptured appendix they'll figure out how to cut through the fat.

There are lots of fertility clinics in the USA. Boston is a big city. Lots of doctors. No need to stay with a doctor who didn't do proper investigations. It's not ethical to not ask questions and run basic tests. Infertility could be a sign of another health issue.

"I often wonder if the people who are pushing for Single-Payer/Medicare For All/Universal Health Care appreciate the reality that such a system would require both rationing and surgical restrictions of such care."

English speakers concentrate on the UK, I guess because of language restrictions. IVF is much, much cheaper in countries that cover it in health care. Czech Republic, places like that. It's about 10 times more expensive in the USA. In fact, if this woman couldn't get a good doctor in the US, she could fly to the Czech Republic. The all-inclusive cost, including airfare and restaurants/ hotels, might be less $$ -- depending on her budget.

Christy said...

I would think bariatric surgeries would provide both practice at cutting through a foot of fat and a baseline for how safe it is.

mockturtle said...

The risk of post-op infection is higher with obese people. It seems reasonable to expect a subject to lose some weight before treatment.

wwww said...

"I've known of cases of people who were considered to thin for surgery too — people who needed cancer removed but had to gain weight first."

Did the doctors think the person was so frail he was was going to die on the table? Seems like a very bad idea to let cancer grow.

mockturtle said...

"I've known of cases of people who were considered to thin for surgery too — people who needed cancer removed but had to gain weight first."

That makes no sense. Sometimes weight gain is recommended prior to chemotherapy which might cause anorexia/nausea in the patient.

Unknown said...

Another problem is that even normal weight mothers are at risk of gestational diabetes, and the obese far more so. In addition, pre-eclampsia, which causes blood pressure to spike and can cause seizures, would be even worse if you already have high blood pressure (as the obese often do). Wreck your health and you will have problems.

Unknown said...

In college I had my appendix out. I was pretty athletic and lean. The surgeon came in the next day and said it was so much easier to sew me up than a fat person--stitches don't hold well in fat.

Michael K said...

The surgeon came in the next day and said it was so much easier to sew me up than a fat person-

That's why pediatric surgery is fun,

Michael K said...

I'm interested in the problem of doing surgery through a very thick layer of fat. You don't hear much about it. The article is specifically about pregnancy, but what about other surgery? Are fat patients rejected?

Once during my residency, I admitted a 700 pound woman whose chief complaint was that she feared she would starve to death as she could no longer get out of bed.

A few days later I was called to see her for suspected appendicitis. I made a foot long incision to get into her belly and took out her appendix, which was not inflamed. It turned out she had polyarteritis nodosa of the appendix (appendiceal artery). She ultimately died of it. I have operated on lots of morbidly obese. I used to do that surgery for a while. We had a guy who weighed almost 900 come in as a trauma. It took two beds and two OR tables

Gospace said...

Without bothering to read the article- the answer is yes to the asked question.

The question unasked is- whose decision should it be- the medical professional, the prospective patient, or a government bureaucrat?

Should a patient be able to demand care that a provide doesn't want to provide? Liberals consistently say "Yes" to this, saying Catholic nurses, doctors, and hospitals should be forced to kill the unborn.

Should the government be able to require or deny care? Governments do that now in many various ways. The quackery known as chiropracty would likely be far less popular in NY if NY State didn't require health insurance to cover it. I have been unable to get an answer from anyone as to how much my health insurance premiums would go down if I were able to stop supporting quacks as mandated by law.

Medical care is full of ethical decisions. And the ethical decisions are often intertwined with financial decisions.

Ingachuck'stoothlessARM said...

can it be said that obesity is unhealthy, or is that 'hate'?

"Help me, Obese Wan"

Ingachuck'stoothlessARM said...

Try the new Venezuelan Diet

socialism cures obesity. For most.

Birches said...

A family member needs a kidney. One of my cousins offered. But she can't because her BMI is too high. It's too hard to do the laparoscopic surgery if you're too fat. So yeah, this is a thing

A C Section needs a much bigger incision than bariatric surgery. You've got to pull a whole baby out of there after all, not just put some instruments inside a stomach.

Yancey Ward said...

Fertility treatments are elective procedures, and not getting pregnant isn't a life-threatening illness. If the medical facility doesn't want to do the procedure on you, tough. Find one that will.

Megaera said...

Many medical procedures, even things as simple as taking vitals or starting an IV, are more difficult and frequently carry more risk in the morbidly obese. Harder to find and palpate a good vein (and you may need a longer-than-normal needle/catheter) more risk of infection, skin is often compromised and weakened...stretchers and other transfer devices should be reinforced and you might have to wait longer for bariatric equipment because of other demand: it's much more expensive and therefore not universally available.

tcrosse said...

I was in for a heart stress test, which involved lying on a table while some sort of scanning apparatus went around me. Next patient up was a Samoan, who tipped the scales at 350. The tech told him the table was only good for 300, so they had to work the phones to find a sturdy enough table for the scan.

Dalben said...

Yes. When I was a resident there were patients we wouldn't operate on until they got their blood sugar down low enough for a long enough time.

Though of course it depends on thr exact circumstances. If a patient needed an amputation or something elses urgent we'd operate regardless. On otjrt caes it was important but not so emergent we'd wait till they were in good enough health to do the surgery, of it was something more elective like a bunion we might just say you're not a good canditate period.

Being obese is also a risk factor for surgical complications. I'm not an ob/gyn but if a particular doctor feels it's not a good risk that's their call.

Dalben said...

Surgery - and other medicine for that matter - is a balancing of risks vs benefits.

There should be no categorical ruling that if you have greater than a certain BMI you can't have surgery. But it's certainly reasonable to say that after a certain pont3the risks begin to outweigh the benefits and many doctors will not want to take on those risks.

wwww said...

One of the docs wouldn't treat anyone with a BMI over 30. That's not 300 pounds. That's, what, about 150 or 160 pounds for a short person.

wwww said...

There's too much "don't get pregnant until things are perfect." The perfect salary. The perfect house. Children are important; the most important thing. It's one thing if the doctor thinks a serious, life-threatening situation is at hand. It's another if the woman is 160 pounds and could stand to loose 15 to 20 pounds.

Michael K said...

One of the docs wouldn't treat anyone with a BMI over 30.<

A friend of mine, a vascular surgeon, would not operate on smokers. I got some patientas from him and was almost always able to get them to quit, at least until after the surgery.

Henry said...

Pregnancy too dangerous?

How about in the Netherlands?

wwww said...

Most births aren't surgeries. One of these women got pregnant from IUI, which is a timing/ turkey baster procedure. That's not an operation. She and her husband put off pregnancy for years because she wasn't "thin" enough.

I don't like the anti-natal push of North American culture. Pregnancy is seen as "bad," and too many call children "burdens." Children are one of the most significant things in life, but this culture scoffs at the incredible events of pregnancy and children.

One of the women in the story was told to abort because she got pregnant and she was overweight. That's the kind of anti-natalist attitude I am talking about.

StephenFearby said...

What to do about metabolic syndrome / obesity?


Trends Neurosci. 2015 Jan;38(1):36-44.
Hypothalamic microinflammation: a common basis of metabolic syndrome and aging.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282817/pdf/nihms642706.pdf


Hypothalamic inflammation in obesity and metabolic disease

https://www.jci.org/articles/view/88878/pdf


The locus of inflammation: cell mitrochondria.

Mol Metab. 2019 Jan;19:24-33.
Moderate weight loss attenuates chronic endoplasmic reticulum stress and mitochondrial dysfunction in human obesity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323177/pdf/main.pdf


Following a ketogenic diet can result in significant weight loss with a positive effect on mitochondrial function (YMMV).

Neurochem Res. 2019 Jan;44(1):22-37.
A Ketogenic Diet Improves Mitochondrial Biogenesis and Bioenergetics via the PGC1α-SIRT3-UCP2 Axis.

https://www.ncbi.nlm.nih.gov/pubmed/30027365

There are other interventions to address mitochondrial inflammation (a variety of nutraceuticals), but it's complicated.

A recent example:

BMC Med. 2019 Jan 25;17(1):18.
A randomised controlled trial of a mitochondrial therapeutic target for bipolar depression: mitochondrial agents, N-acetylcysteine, and placebo.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346513/pdf/12916_2019_Article_1257.pdf

mockturtle said...

I don't like the anti-natal push of North American culture. Pregnancy is seen as "bad," and too many call children "burdens." Children are one of the most significant things in life, but this culture scoffs at the incredible events of pregnancy and children.

Perhaps there are data to support your assertion but my own empirical observation is that young couples are having children--and lots of them. It's wonderful to see so many families out camping and enjoying the outdoors together. I've seen more baby strollers [are they still called that?] recently than I have in years.

wwww said...

Empirically a lot of people around us are having children too. I mean the cultural attitude: "children are a burden" "wait to have kids until you're to X place in your career" "that's too many kids" "life is happier without kids."

"she should get an abortion because she's too fat" -- that's a culturally disordered thought.

Bob Loblaw said...

We had a guy who weighed almost 900 come in as a trauma. It took two beds and two OR tables

How long can a person live at that weight? I mean, that has to be a huge strain on the heart.

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heyboom said...

@Birches

A C-section incision can be as small as 10cm. Essentially, long enough to get the baby's head out.

Nichevo said...

The article is specifically about pregnancy, but what about other surgery? Are fat patients rejected?

Yes, it happens. Hernia operations for one.

mockturtle said...

The article is specifically about pregnancy, but what about other surgery? Are fat patients rejected?

If the surgery is elective, possibly.

Narayanan said...

Breasts reduction surgery ... Is that obesity of the upper chestal ?

Skippy Tisdale said...

"The article is specifically about pregnancy...Are fat patients rejected?"

Who in the world is getting fatties pregnant?