Thursday, September 10, 2009

Blood Pressure

Recently, during my Obstetrics rotation, I saw a woman with very high blood pressure. She was 36 weeks pregnant. I wondered whether her blood pressure was elevated due to the cuff being too small. I asked around, and a few people vaguely remembered that there was once a large cuff but they weren't sure where it was. I eventually found a thigh-sized cuff which gave a much lower reading. It may have been inaccurate too, because the thigh cuffs tend to be too wide for fat arms (unless the fat arms happen to belong to a very tall person).

Nobody else really seemed to think the lack of an appropriate BP cuff was a big deal. I think it's not just a big deal, but totally unacceptable. There needs to be a large cuff available in every ward in every hospital that treats a general adult population. Too-small cuffs directly affect patient care.

Here's a pie-in-the-sky dream: I wish we (the fat acceptance & HAES communities) could raise money to send one-piece large-cuff sphygmomanometers (like the Welch-Allyn DS44-12) to hospitals and clinics, along with a letter discussing the importance of providing appropriate care to large patients!

Edited to add: Thanks to living400lbs for providing the link to Well-Rounded Mama's excellent series about the need for large blood pressure cuffs.

Tuesday, September 8, 2009

Weight Stability

A while back, I attended a tutorial where we discussed a fictional patient case. In the introduction, the patient is described as having gained 45 lbs over the past three years. Most students seem to believe that this is a reasonable amount for someone to gain simply based on becoming more sedentary and adopting a worse eating style.

I strongly disagreed. I think that the vast majority of the time when someone has a stable weight for years and then suddenly gains a significant amount of weight (175 to 225 lbs, in this case) it's almost always going to have a medical cause. Our bodies cling to our setpoints quite voraciously. It's HARD to gain that much weight from a stable beginning. Of course, there are exceptions: chronic dieters, psychiatric illnesses such as depression, and individuals who happen to be unusual weight gainers or losers.

It took me a while to figure out why this was making me so angry. I think that this attitude that it's so easy to just gain 50 lbs if you 'let yourself go' is behind this idea that somebody who is thin is actively doing something right to maintain their weight. So if somebody is thin it follows that they are maintaining a 'good' lifestyle. If they adopted a 'bad' lifestyle, they would become fat. That is, naturally thin folks have a vested interest in believing that it is easy to gain weight because the conclusion drawn is that they have a good, virtuous lifestyle that has earned them the right to be thin.

Of course, if somebody unintentionally LOSES any weight (even 10 lbs lets say) we'd be all over a medical cause for it!