Guest guest Posted February 17, 2008 Report Share Posted February 17, 2008 It's been a long time since we talked about medicine, hasn't it? A frequent topic of conversations among medics who have been around for a long time, as I have, concerns the drastic increase in morbidly obese patients we see. Thirty years ago when I started, folks were just not that fat. Once in a while we had an obese patient, but they were the exception rather than the rule. In my last job before retiring again last July, more of our patients were obese than not. So, here's a little scenario to see what you know or can find out about obesity. Enjoy. One day, while you are moonlighting at a Doc-in-the-Box, a 27 year old male waddles in, accompanied by his cousin who has driven him there, complaining of knee and leg pain. He is morbidly obese, and your scale pegs him at 412 pounds. He is 5'6 " tall. As you take his history, you ask all the pertinent questions about his condition, and he tells you that he has been obese all his life, ever since he can remember. His cousin relates that he has never felt " full " in his life, and though he eats very slowly, he continues to eat and eat and eat and cannot stop. His cousin says that sometimes they have caught him eating dog food and garbage and stealing food from others. According to the cousin, he will eat everything in sight and never stop and has been known to become violent when competing for food with his family and friends. He eats constantly. As you continue to question him you begin to get the impression that his intelligence level is somewhat lower than most of your patients. It becomes apparent that the reason that the cousin is chiming in with answers to some of your questions that this is a routine that has developed over a long period of time. The cousin is protecting the patient by answering for him when he fal ters. When you perform a physician exam you note that he seems to have poor muscle tone, and that his genitalia are not well developed and he has very little pubic hair. You also suspect that he has some pedal edema although it is very hard to decide since his legs are so fat. His BP is 160/118, and he denies taking any antihypertensives. His pulse is 104, respirations 26, and you hear some fine crackles in his lungs. A 12-lead ECG reveals sinus rhythm at 104, and a prominent P pulmonale. You measure the S wave in V1 and the R wave in V6 and add them together and come up with 52 mm. (Why did you do this and what does the result tell you?) Examination of his legs, knees, and hips reveals no point tenderness. He describes his pain as chronic, and he admits that it's probably because " I'm too fat. " As you complete your H/P and have a short conference with your physician/employer, he asks you, " What do you think his problem is other than he's morbidly obese? What is the cause? " How would you answer his question? How about you docs hold off till the medics get a chance? If you want to add some pertinent questions, that would be great. Gene G. ************** Ideas to please picky eaters. Watch video on AOL Living. (http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/ 2050827?NCID=aolcmp00300000002598) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2008 Report Share Posted February 17, 2008 I'm trying to remember the disorder's name, but I seem to vaguely recall some sort of endocrine disorder. -Wes Ogilvie In a message dated 2/18/2008 12:18:18 A.M. Central Standard Time, wegandy1938@... writes: It's been a long time since we talked about medicine, hasn't it? A frequent topic of conversations among medics who have been around for a long time, as I have, concerns the drastic increase in morbidly obese patients we see. Thirty years ago when I started, folks were just not that fat. Once in a while we had an obese patient, but they were the exception rather than the rule. In my last job before retiring again last July, more of our patients were obese than not. So, here's a little scenario to see what you know or can find out about obesity. Enjoy. One day, while you are moonlighting at a Doc-in-the-Box, a 27 year old male waddles in, accompanied by his cousin who has driven him there, complaining of knee and leg pain. He is morbidly obese, and your scale pegs him at 412 pounds. He is 5'6 " tall. As you take his history, you ask all the pertinent questions about his condition, and he tells you that he has been obese all his life, ever since he can remember. His cousin relates that he has never felt " full " in his life, and though he eats very slowly, he continues to eat and eat and eat and cannot stop. His cousin says that sometimes they have caught him eating dog food and garbage and stealing food from others. According to the cousin, he will eat everything in sight and never stop and has been known to become violent when competing for food with his family and friends. He eats constantly. As you continue to question him you begin to get the impression that his intelligence level is somewhat lower than most of your patients. It becomes apparent that the reason that the cousin is chiming in with answers to some of your questions that this is a routine that has developed over a long period of time. The cousin is protecting the patient by answering for him when he fal ters. When you perform a physician exam you note that he seems to have poor muscle tone, and that his genitalia are not well developed and he has very little pubic hair. You also suspect that he has some pedal edema although it is very hard to decide since his legs are so fat. His BP is 160/118, and he denies taking any antihypertensives. His pulse is 104, respirations 26, and you hear some fine crackles in his lungs. A 12-lead ECG reveals sinus rhythm at 104, and a prominent P pulmonale. You measure the S wave in V1 and the R wave in V6 and add them together and come up with 52 mm. (Why did you do this and what does the result tell you?) Examination of his legs, knees, and hips reveals no point tenderness. He describes his pain as chronic, and he admits that it's probably because " I'm too fat. " As you complete your H/P and have a short conference with your physician/employer, he asks you, " What do you think his problem is other than he's morbidly obese? What is the cause? " How would you answer his question? How about you docs hold off till the medics get a chance? If you want to add some pertinent questions, that would be great. Gene G. ************** Ideas to please picky eaters. Watch video on AOL Living. (_http://living.http://living.http://living.http://livihttp://livinghttp://liv ing_ (http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/\ ) 2050827?NCID=2050827?NCID=<WB20508 [Non-text portions of this message have been removed] **************Ideas to please picky eaters. Watch video on AOL Living. (http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/ 2050827?NCID=aolcmp00300000002598) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2008 Report Share Posted February 18, 2008 wegandy1938@... wrote: " When you perform a physician exam you note that he seems to have poor muscle tone, and that his genitalia are not well developed and he has very little pubic hair. You also suspect that he has some pedal edema although it is very hard to decide since his legs are so fat. " Gene- any alopecia or friable hair? Is the skin dry and/ or flaky? Does the patient have problems staying awake? " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 --------------------------------- Looking for last minute shopping deals? Find them fast with Yahoo! Search. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2008 Report Share Posted February 18, 2008 Gene, Sounds Like Prader-Willi syndrome Mark Elliott LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2008 Report Share Posted February 18, 2008 None of those are present. GG > > > > wegandy1938@wegandy wrote: > > " When you perform a physician exam you note that he seems to have poor > muscle > tone, and that his genitalia are not well developed and he has very little > pubic hair. You also suspect that he has some pedal edema although it is > very > hard to decide since his legs are so fat. " > > Gene- any alopecia or friable hair? Is the skin dry and/ or flaky? Does the > patient have problems staying awake? > > " A prudent man foresees the difficulties ahead and prepares for them; the > simpleton goes blindly on and suffers the consequences. " A prudent man fo > > ------------ -------- -------- -- > Looking for last minute shopping deals? Find them fast with Yahoo! Search. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2008 Report Share Posted February 18, 2008 YOU GOT IT! GG ************** Ideas to please picky eaters. Watch video on AOL Living. (http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duff y/2050827?NCID=aolcmp00300000002598) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2008 Report Share Posted February 23, 2008 That disorder was a topic of a CSI show once. smelliott417 wrote: Gene, Sounds Like Prader-Willi syndrome Mark Elliott LP Danny L. Owner/NREMT-P PETSAR INC. (Panhandle Emergency Training Services And Response) Office Fax Quote Link to comment Share on other sites More sharing options...
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