Ok so Im gonna steal this next post because it struck a chord with me. Some of you know that I am going back to school after years of modeling to become a nurse. I have ALWAYS held a sincere fascination about how the body works and how we can heal ourselves but this post on Diary of a Mad Fat Woman really hit home. You can not DENY that fat can hurt a body after looking at these images and reading the commentary by Amanda’s fiance Jason. Read the post, look at the pictures and decide for your self. I did and I am glad that it was able to solidify my reasoning to finally get healthier:
The original post:
http://amadfatwoman.blogspot.com/2011/08/big-picture-what-mri-can-tell-us-about.html
Last week I wrote a post titled “
Fat and Happy, Fat and Fit: A Contradiction?“ This is a sort of follow up to that post – but not the kind you’re thinking. I want to be clear on something: I
do believe its possible to be fat, fit, and happy. However, being simultaneously fat
and healthy is undoubtedly difficult, and takes more work to achieve than it would for a “thin” person. What is my point? My point is this:
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| IMAGE 1 – MRI |
The image on the left is NOT fat and fit, fat and healthy, or fat and happy.
Wow. Right?
This image has been floating around the internet, and making its way through all of the weight loss blogs. I have yet to find its original source, so I decided to bring in a “guest blogger” to help me break it down.
Some of you may know my fiancé, Jason, works in
radiology &
nuclear medicine at one of the best hospitals in the country, and
the number one hospital in Pittsburgh. He has many duties – primarily he injects patients with radioactive isotopes in order to take different types of “images” of the various parts of the body. He performs different “studies” to help diagnose illness and disease, and he has shared many stories with me about patients he sees who are morbidly obese (all within HIPPA guidelines, I assure you).
I sat down with Jason and showed him the image above, and asked him to talk about what he sees at work, as well as to analyze the image to the best of his ability.
*** Disclaimer: Jason is NOT a radiologist, or medical doctor. The information given here is based purely on his schooling, and his years working in radiology. ***
A: Tell me what you see when you look at the MRI image of the obese vs. the thin person?
Cardiomegaly : A medical Condition in which the heart becomes severely enlarged. This can lead to several other health issues, including congestive heart failure. One in 3 cases of Congestive Heart Failure is attributed to cardiomegaly.
Osteoarthritis: also known as
degenerative arthritis or
degenerative joint disease, is a group of
mechanical abnormalities involving degradation of joints,including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion (commonly “fluid on the knee”). You can see the image on the left shows that the joints – in particular the hips and ankles, are misaligned.
Fatty Liver Disease: A disease of the liver caused by excessive storage of fat. FLD can lead to
Steatohepatitis, a type of hepatitis caused by liver inflammation. Steatohepatitis can progress to
cirrhosis, and ultimately lead to liver failure if left untreated.
IBS or other digestive issues: Jason included Irritable bowel syndrome as a sort of “blanket” diagnosis. The image shows “black pockets in the intestinal tract which indicated the presence of large amounts of air or gas”. Large air pockets are often associated with people who suffer from a number of gastrointestinal afflictions, including but not limited to IBS. Common symptoms of IBS are bloating and abdominal distention.
“
Massive Amounts of Adipose“: You can see in the image that the yellowish tissue is adipose, or fat. What is most obvious is the amount of subcutaneous adipose deposited in the most expected areas: the arms, midsection, and thighs. But the more shocking and life threatening condition is the presence of both
visceral adipose and
epicardial adipose tissues:
Visceral Adipose: Visceral fat, also known as organ fat or
intra-abdominal fat, is located inside the peritoneal (abdominal) cavity, packed in between internal organs and torso, as opposed to subcutaneous fat which is found underneath the skin, and intramuscular fat which is found interspersed in skeletal muscle. Visceral Fat is associated with higher risk of
heart disease,
hypertension,
insulin resistance, and
Type 2 Diabetes.
I also specifically asked about the differences in the brain region. He said that because the MRI is sliced and centered in order to show the same areas of the body, the positioning of the brain on each slice is different. So the different colors between the image on the left and the image on the right are just caused by the brain being “sliced” at a slightly different region. What looks like fat is actually a normal part of the brain. So, he really can’t see any difference in the brain – and would require an HRMRI of the brain itself, sliced differently, in order to compare.
I did a sort of Q&A with him, just to get some more info, because at this point I was pretty interested.
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A: In your career would you say you see a lot of issues that are caused primarily by obesity?
J: Yes.
A: What are some of the most common things?
J: Problems with the gallbladder. Arthritis.
A: People get scans for arthritis??
J: Well, they get scans for “leg pain” and they find out its arthritis because their frame can’t support their body weight. Arthritis affects joints – it causes rubbing. One of the reasons you get arthritis is because you have all this weight pushing on – compacting- the joints. So instead of them being fluid because there is liquid in between, there is a rubbing & grinding, because its too heavy for your frame. That why I keep telling you you better lose weight now because as you get older its too late. She [image 1] probably also has back pain or spinal issues. Even though you can’t see the spine in this you can guess – because its so common in someone that big. As well as leg pain… look at her feet – you can see she has a misalignment of the ankles. We also do a lot of scans for PE (pulmonary embolism) due to “non activity”.
A: Because people who are sedentery are more suspectible to PE?
J: Exactly. Another big thing is the lack of quality care overweight people recieve.
A: Whys that?
J: They’re too big to be properly diagnosed by our equipment.
A: Like, their weight exceeds the weight limits of the machines?
J: Not only that, but the excessive fat makes it difficult to see if there are problems. It attenuates radiation. The radiation can’t break through the adipose. It lowers the quality of the image. Its grainy – you get “noise” on the image instead of a clear crisp image.
J: The big thing is people who are overweight get worse medical care – but they need more medical care. There are people that we have to turn away because they’re too big to fit into our scanners. We just can’t get proper scans done on them.
A: How big would you have to be for that to happen?
J: As low as 350lbs at our hospital. And smaller hospitals that don’t have the better equipment, maybe even less. You would think that that’s high [weight], but its really not.
A: Well, no, its not really that much. If that woman there [image 1] is 250lbs and 5’6, I’m sure its not difficult to find a 6ft tall man who is 350+ pounds. What would they do in a case like that? They just get turned away, and they can’t get the scan at all? Aren’t there other hospitals that have larger cameras or scanners?
J: Well the rumor is that they have had to send people to the Pittsburgh Zoo to use their cameras. I’ve heard coworkers talk about it. I’ve never actually seen it happen myself though. But that’s what they say.
A: But have you personally turned people away?
J: Yeah, I’ve turned away plenty of patients because they’re too big.
A: And then what does the hospital do?
J: Whatever they can do without the scan. Heres the problem: the doctor has less reliable information in order to make an informed diagnosis and give medical treatment. So fat people get worse medical care because the doctor has to make an educated “guess” a lot of the time. Whereas, if we could have done a CT on the person, a quality CT, we would have caught that nodule of cancer, or seen where they have a stress fracture or something. Oh, This is a good example, look at this – this person doesn’t even fit into the machine:
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| IMAGE 2 – CT (Jason did a google search for patients too big for imaging) |
J: … Here the person is bigger than the field of view. See this white? That’s their bones – their frame. This white spot in the middle is their spine. The lighter grey in the center is their internal organs. And all this grainy darker grey around the outside – that’s all fat. So the CT can’t even take a picture of some parts because it can’t fit around them. And the grainy quality of the image is what I was talking about earlier – the “attenuation” because the rays are absorbed by some of the fatty tissues. So it makes it harder to diagnose problems, you see?
Another thing is, you know, bigger people need more radiation to get the same quality image as someone of a healthier weight. For example, a CT uses a method called “care dose” or “smart dose” – where the machine automatically adjusts the amount of radiation in order to get the best quality image possible. Now for someone who is bigger, they have a lot of adipose tissue to penetrate, the machine will adjust the CT – and sometimes they end of with a lot more radiation than they should have because that’s how much it takes to penetrate. Sometimes its more than twice the amount that it would be for someone of a healthier weight. But you know, you have to take the image because it could be for a serious health problem – life or death.
Sometimes we will get images like this [image 2], and we’ll look at an image and say ‘look at how tiny his/her rib cage is inside all of this fat’ – People don’t realize that your bones are the same size, no matter how much fat you put on top. And that is one of the things that causes so many problems. Your bones, your heart, lungs, liver… its not meant to support all of that excess weight and fat.
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After I finished talking with Jason I decided to do some more research on the subjects. While I was able to find statements from the American College of Radiology to discredit the ability of Zoo’s to scan obese patients, I also found out that there are many calls to zoos all over the country from Doctors themselves requesting MRI, CT, XRay, & NucMed scans of morbidly obese patients.
I decided to call the local “Open MRI” provider to see if their “open” MRI was able to handle heavier folks. I was informed by the receptionist that the limits on their machines are 300lbs, and only 17″ in width. She referred me to another local hospital. Their receptionist informed me that the weight limit is 350lbs, and the width is “about an arm length, but we suggest that larger patients come in and view the machines themselves first.”
These are issues I’ve never really thought about. Of course my family has a history of diabetes, so I’ve always been aware that I’m at risk. But the other things – osteoarthritis, PE, fatty liver disease, heart disease, congestive heart failure, cardiomegaly… those are things that I’ve never thought of. And I certainly have never considered how difficult it might be for a doctor to properly diagnose an illness or disease. Can you imagine not knowing you have cancer because you had to much belly fat to detect it? And I’m sure it happens much more often than we realize.
Just one more reason to get off that couch, and go for a walk, take a swim, cruise on your bike. Because your life depends on it!
Until next time,
-a
Kinda eye opening, right?
Love youse
-V
I am excited for the next chapter in all this. Right now my focus will be on maintenance and enjoying myself.
