I have had so many surgeries for joint replacement; hernia repairs; babies; cancer and weight loss (irony!). I remember over 20 years ago being referred to an orthopedic surgeon because my right hip hurt so much I couldn’t put any weight on it, osteoarthritis. The surgeon examined me and said I was too heavy to receive a new joint and that it would wear out in 5 years. This was a judgement from a man who was in his 60’s and overweight himself. In British Columbia all joint replacement surgeries go through a vetting process by a committee that has the recommendations and prioritizing of the surgeon. 7 years later, with the support of my amazing family doctor, Michele Fretz, a realistic orthopod, and after being on morphine; the wait list for 5 years and then, CBC news about long wait lists, I got my first joint replacement.
Now, for any surgery, even though I’ve lost over 80 pounds from my highest of 300, I go through a very thorough per-surgery regimen that includes: full check-up; x-rays; echo cardiogram; electrocardiogram; blood work; and at least 4 interviews with: pharmacist; anesthesiologist; endocrinologist; critical care doctor etc. So, if I was still morbidly obese, I would not have had the last surgery just the hysterectomy. Our health system, and health systems almost everywhere, are reluctant to help morbidly obese patients due to the risks and they may die anyways. We each need to be evaluated on quality of life and a realistic evaluation of success.
The following is an article in the Victoria Times-Colonist and warns people of another reason to lose weight. DO IT!
Thanks for listening! ;D Diane
Obese B.C. patients often face surgery delays: report
Surgeons in B.C. say they often postpone, cancel or even decline to do surgery on obese patients because of worries about complications and demands on hospital resources, all known to be higher in patients with a body mass index (BMI) over 30.
The gaps in surgical care for obese patients are reported in the current B.C. Medical Journal. Nearly 400 physicians across the province responded to a questionnaire sent to general surgeons, orthopedic surgeons, obstetrician/gynecologists and anesthesiologists.
Dr. Mark Dickeson, a co-author and general surgeon at Burnaby Hospital, acknowledged in an interview the concerning results: • Ninety-six per cent of surgeon respondents have delayed or declined to perform elective surgery in patients with a BMI higher than 38; • Nearly 80 per cent of surgeons delayed or declined to perform surgery due to concerns about complications in obese patients with a BMI of 30 to 34; • Patients whose cases are postponed or cancelled because of obesity either have to seek care elsewhere or go without surgery.
“With the well-documented risks and costs associated with caring for obese patients, it is not surprising that surgery for these patients is postponed or denied. This is especially concerning because comorbidities related to obesity, including gallstones, reflux, osteoarthritis, and certain malignancies, frequently require surgical intervention,” the article states.
Anesthesiologists reported they typically must modify their management of patients, according to the article.
“Anesthetic challenges arise when managing and monitoring the cardiopulmonary systems and when dosing perioperative medications. A thick neck, heavy chest and abdomen, high gastric residual volume, reduced functional residual [pulmonary] capacity, and potential underlying sleep apnea and/or hypoventilation syndrome all contribute to difficulties with airway management and ventilation,” it said.
Some of the challenges and complications of surgery in obese patients are: longer operations, longer hospital stays, higher rates of infections, higher operation failure rates, more hospital readmissions, more invasive surgery and higher risks of adverse events during surgery like injury to other organs because surgeons have trouble visualizing the surgical field due to “obscured anatomical landmarks.” Obese patients also have higher risks of blood clots, cardiac arrest and death after surgery.
Three-quarters of survey respondents think the provincial government should have at least a few hospitals in the province established as centres of excellence for managing obese surgical patients. Having hospitals with higher volumes of such patients and surgeons with more experience operating on obese patients would likely mean fewer complications, he said. As well, surgeons should be paid higher fees for operating on obese patients since cases take so much longer, he said.
Kristy Anderson, spokeswoman for the ministry of health, said the health minister needs to review the article before commenting but “providing safe, high-quality care is paramount to the ministry, health authorities and care providers.”
PAMELA FAYERMAN, 10 Jul 2016 Times Colonist-Vancouver Sun