Adding Metformin to VPA to control weight gain?
I have a moderately obese gentleman with Schizoaffective disorder and Meth use history who is still having a lot of AH and mood instability on VPA 1,000 mg, Risperdal 8 mg, Trazodone 150 mg and Wellbutrin 150 mg BID (has been snorting at group home a few times). His BMI is 37 and he wants to switch to Zyprexa as it worked for him in the past. I told him I would need labs before making any changes. But if I decide to cross-taper to Zyprexa, will adding the Metformin also help with the weight... Adding Metformin to VPA to control weight gain? (Source: Student Doctor Network)
Source: Student Doctor Network - October 20, 2020 Category: Universities & Medical Training Authors: shahseh22 Tags: Psychiatry Source Type: forums

Measuring of central obesity could be improved
(Source: BMJ Comments)
Source: BMJ Comments - October 1, 2020 Category: General Medicine Source Type: forums

Tachycardia Case
You're on call and the board is starting to clear up. You drop your last patient off in pacu and see that a ortho addon has been posted to the board. You go to see the patient and this is the history you obtain. 65 yo m with pmh remote cva with left hemiplegia, htn, dm2, obesity who fell and presented with a left patellar fracture as well as trace frontal sah. The first thing you noticed when you went to see the patient is that he is laying comfortably in the hospital bed, chatting with... Tachycardia Case (Source: Student Doctor Network)
Source: Student Doctor Network - September 27, 2020 Category: Universities & Medical Training Authors: GassYous Tags: Anesthesiology Source Type: forums

RFA machine shopping: needs: perpendicular lesion ability and multilesion ability
Just as the thread title states. I currently utilize the Kimberly-Clark/halyard/Avanos machine. It is what I used in fellowship and when started in practice a little more than 10 years ago I got the same one. I really like cooled RFA in the lumbar spine especially for obese patients or patients with tough anatomy. It is great to be able to come in perpendicular because you get a very true view of the junction being squared up and you are obliqued so you get anterior enough without... RFA machine shopping: needs: perpendicular lesion ability and multilesion ability (Source: Student Doctor Network)
Source: Student Doctor Network - September 25, 2020 Category: Universities & Medical Training Authors: specepic Tags: Pain Medicine Source Type: forums

Idiopathic intracranial hypertension
Typical overweight female with classic symptoms. POCUS with large ONSD. How many of you guys are doing the LP in the ER? Any evidence that this needs to be done emergently? Do you admit for MRI/MRV? Do you start them on acetazolamide before confirming dx? (Source: Student Doctor Network)
Source: Student Doctor Network - September 14, 2020 Category: Universities & Medical Training Authors: Bougiebuster Tags: Emergency Medicine Source Type: forums

What is your approach to difficult IV access?
How do you guys manage difficult IV access intraop (say for your super morbid obese vasculopaths)? Any cool methods or tips/tricks that I am missing? 1) Peripheral IV in any extremity -Blind saphenous if peds -IO if emergency 2) US for obvious superficial targets in the extremities 3) US guided IV into deep vessel (basilic or brachial) 4) EJ 5) Central line (Source: Student Doctor Network)
Source: Student Doctor Network - September 11, 2020 Category: Universities & Medical Training Authors: propofabulous Tags: Anesthesiology Source Type: forums

Re: body analysis vs BMI as obesity measure
(Source: BMJ Comments)
Source: BMJ Comments - September 9, 2020 Category: General Medicine Source Type: forums

The pandemic intensifying the obesity epidemic
(Source: BMJ Comments)
Source: BMJ Comments - August 25, 2020 Category: General Medicine Source Type: forums

Crazy wakeup in morbidly obese patient
Wanted to get anybody's thoughts on how they would've handled it. Last week, there was a 600 lb patient undergo ECT. We were thinking of either doing it under LMA or ETT, but she was mallampati I and surprisingly easy to mask ventilate with oral airway) once she went to sleep. We used methohexital, ketamine, sux (while ramped and reversed T). Psych performed ECT and patient desatted to 70s (which was expected). I placed oral airway back in and ventilate back up to 95% and everything was... Crazy wakeup in morbidly obese patient (Source: Student Doctor Network)
Source: Student Doctor Network - August 25, 2020 Category: Universities & Medical Training Authors: osoprop28 Tags: Anesthesiology Source Type: forums

Obesity strategy still hindered by the Market Environment?
(Source: BMJ Comments)
Source: BMJ Comments - August 20, 2020 Category: General Medicine Source Type: forums

Re: Partha Kar: Our approach to tackling obesity needs rethinking
(Source: BMJ Comments)
Source: BMJ Comments - August 20, 2020 Category: General Medicine Source Type: forums

Combating the obesity epidemic
(Source: BMJ Comments)
Source: BMJ Comments - August 18, 2020 Category: General Medicine Source Type: forums

Re: Obese and hungry: two faces of a nation
(Source: BMJ Comments)
Source: BMJ Comments - August 18, 2020 Category: General Medicine Source Type: forums

case - options for pain control
40 yo F morbid obesity (BMI 50 w/ OSA requiring CPAP) presents for bariatric surgery - laparoscopic. H/o Chiari malformation, h/o hydrocephalus w/ ventricular-thoracic shunt and lumbar-peritoneal-shunt s/p multiple revisions for failure and optic nerve fenestration for blindness, chronic neck/headaches on Norco 10-325, gabapentin 300 once daily, flexeril, fibromyalgia. Thoughts on pre-intra-post operative pain control options? Neuraxial? Multimodal? How would you manage her preop opioid use? (Source: Student Doctor Network)
Source: Student Doctor Network - July 28, 2020 Category: Universities & Medical Training Authors: mtu620 Tags: Anesthesiology Source Type: forums

Childhood obesity crisis: a comprehensive strategy with high-level political support is needed.
(Source: BMJ Comments)
Source: BMJ Comments - July 22, 2020 Category: General Medicine Source Type: forums

Covid-19: Intake-related Strategies for Tackling Obesity
(Source: BMJ Comments)
Source: BMJ Comments - July 19, 2020 Category: General Medicine Source Type: forums

Challenging case
Had an interesting case recently, wondering how others would have tackled it: 72 yo M with poorly controlled HTN, IDDM, morbidly obese (190kg), pAF, CAD s/p remote CABG complicated by ischemic CM (LVEF 25% w/ RWMAs), post-capillary pulmonary HTN (mPAP ~50, R heart dilated and mildly reduced fxn), and AS s/p TAVR now w/ severe prosthetic valve stenosis. ESRD on HD, however he is now progressively volume overloaded because he has been getting hypotensive during attempts at ultrafiltration... Challenging case (Source: Student Doctor Network)
Source: Student Doctor Network - July 6, 2020 Category: Universities & Medical Training Authors: Hork Bajir Tags: Anesthesiology Source Type: forums

Pandemic - ‘Action This Day’ – Measure Vitamin D in COVID-19 Patients – Time is of Essence – BAME, Elderly and Obese are Disproportionately Dying
(Source: BMJ Comments)
Source: BMJ Comments - June 26, 2020 Category: General Medicine Source Type: forums

Let ’s do another case
Add-on periectal abcess. Healthy Mildly obese 40yo female. She had this same procedure a year ago and ended up in the ICU for 4 days afterwards because of an MH event. PMH: in significant other than MH. and some scoliosis. PSH: above Labs normal PE: normal she is extremely anxious since she “almost died” last time she was here. Questions? Plan? (Source: Student Doctor Network)
Source: Student Doctor Network - June 23, 2020 Category: Universities & Medical Training Authors: Noyac Tags: Anesthesiology Source Type: forums

Obesity - a potential risk factor for COVID-19 associated morbidity and mortality in urban Bangladesh
(Source: BMJ Comments)
Source: BMJ Comments - June 20, 2020 Category: General Medicine Source Type: forums

Recycling ideas from biking and solar power subsidies: a preventative approach to obesity
(Source: BMJ Comments)
Source: BMJ Comments - June 17, 2020 Category: General Medicine Source Type: forums

Re: Obesity and covid-19: the role of the food industry
(Source: BMJ Comments)
Source: BMJ Comments - June 16, 2020 Category: General Medicine Source Type: forums

Back to normal
Not what you think. But I haven’t been present on this forum for a few months, so I thought I would post a case. 69yo morbidly obese ( BMI 48) female with severe COPD for a shoulder surgery, RCR. A little more history reveals chronic paroxysmal A fib with PSVT/RVR yada yada yada PFT’s show
Source: Student Doctor Network - June 12, 2020 Category: Universities & Medical Training Authors: Noyac Tags: Anesthesiology Source Type: forums

Adversity prompt feedback - overcoming obesity vs bad grades vs sports injury
I'm stuck. Do I use the adversity essay to explain bad grades? I would prefer not to, because I cannot discuss the true circumstances of my bad grades 10 years ago (drinking problem), only discuss my growth in vague language, so it feels stupid. Current list of topics: "Overcame myself and my terrible grades" I was bullied as a kid for being fat, became obese as an adult, dx prediabetic, made drastic changes, attained healthy body weight, it was really hard. I can relate to my... Adversity prompt feedback - overcoming obesity vs bad grades vs sports injury (Source: Student Doctor Network)
Source: Student Doctor Network - May 25, 2020 Category: Universities & Medical Training Authors: helpconfusedpremed Tags: Pre-Medical - MD Source Type: forums

Obesity Medicine For Internists
Does anyone have any experience with practicing full-time obesity medicine? I am specifically interested in the possibility of transitioning from primary care and what a model for that would look like. I graduated from an academic IM residency in the northeast four years ago, passed the ABIM exam, and have been practicing as a PCP since then. I recently discovered that the ABOM exists as a stand alone board, which as of now is not yet recognized by the ABMS, but which has been increasing... Obesity Medicine For Internists (Source: Student Doctor Network)
Source: Student Doctor Network - May 16, 2020 Category: Universities & Medical Training Authors: ColonelForbin Tags: Internal Medicine and IM Subspecialties Source Type: forums

Minimum duration 15 mg iso bupiv with epi
Oral board type case: Knee removal of antibiotic spacer, placement of new implant. Obese, COPD/asthma, MH susceptible, on Coumadin (held) INR 1.2. Prefer to do spinal MAC, AWARE I COULD do CSE but seems like a pain in her and INR 1.2. So... a big boy dose of iso bupiv 12-15 mg with epi and narcotic should be VERY likely to last 4 hours, yes? (Haven’t used tetracaine in 20 years) (Source: Student Doctor Network)
Source: Student Doctor Network - May 14, 2020 Category: Universities & Medical Training Authors: caligas Tags: Anesthesiology Source Type: forums

COVID-19 ’ICU’ risk – 20-fold greater in the Vitamin D Deficient. BAME, African Americans, the Older, Institutionalised and Obese, are at greatest risk. Sun and ‘D’-supplementation – Game-changers? Research urgently required.
(Source: BMJ Comments)
Source: BMJ Comments - April 24, 2020 Category: General Medicine Source Type: forums

Re: Covid-19: a puzzle with many missing pieces. Air pollution, climate and obesity could be the COVID 19 puzzle missing pieces
(Source: BMJ Comments)
Source: BMJ Comments - April 21, 2020 Category: General Medicine Source Type: forums

Prevent obesity risk by not elevating satiety threshold levels by conditioning.
(Source: BMJ Comments)
Source: BMJ Comments - April 16, 2020 Category: General Medicine Source Type: forums

Difficult Airway - Covid, Angioedema, ETT Exchange
Thoughts on the following case: Morbidly obese patient in ICU, thick neck+Covid, respiratory failure, high vent settings (20 PEEP, 70% FiO2). Called by ICU attending to exchange ETT because it becomes kinked when turning the patient prone, and randomly when turning the patient's head in certain directions when supine. Patient also with severe angioedema of the tongue, which is protruding several centimeters from the mouth, firm, immobile, making access to the oropharynx impossible. Patient... Difficult Airway - Covid, Angioedema, ETT Exchange (Source: Student Doctor Network)
Source: Student Doctor Network - April 9, 2020 Category: Universities & Medical Training Authors: inflamesdjk02 Tags: Anesthesiology Source Type: forums

Esophageal nodal failure -
Hello. Looking for any input on this challenging case. 58 yo male, obese. neoadj chemo (carbo/taxol)-XRT (50.4 Gy total dose as 41.4 then boost gross disease) for cT3N0 GE junction adeno completed 7/2018. Ivor Lewis Esophagectomy 10/2018 with 4mm residual disease ypT1bN2 (4 nodes + out of 18 submitted). 1 year later (11/2018) on imaging he has a high level 4R mediastinal node look slightly larger. It is above his anastomosis (at carina) and above his prior radiation. It's hot on PET... Esophageal nodal failure - (Source: Student Doctor Network)
Source: Student Doctor Network - April 1, 2020 Category: Universities & Medical Training Authors: BobbyHeenan Tags: Radiation Oncology Source Type: forums

Do you judge your overweight classmates?
We all know how unhealthy it is to be overweight, and how it can even affect how residencies select you. Regardless of how you feel about the latter, I was wondering if people here personally judge their bigger classmates. I feel like it’s difficult to tell patients to exercise and eat healthy if you don’t as well. (Source: Student Doctor Network)
Source: Student Doctor Network - February 15, 2020 Category: Universities & Medical Training Authors: CidHighwind Tags: Medical Students - MD Source Type: forums

Intubation in trauma patient stem
Saw a bunch of you recommend UBP for oral board so i decided to take a look... yet the first stem they gave i already have some questions about either the book or my ability to practice anesthesia. Is the oral board really expecting me to give answers like this? stem: super morbid obese 5'7 180kg. 22 yr old in vehicle trauma gcs 9, with signs of basilar fracture, facial fracutre, multiple loose teeth, tachy 130s, bp 170s, sat 96% on non rebreather, 33C temp. Q: Patient becoming more... Intubation in trauma patient stem (Source: Student Doctor Network)
Source: Student Doctor Network - February 10, 2020 Category: Universities & Medical Training Authors: anbuitachi Tags: Anesthesiology Source Type: forums

Best way to counter "US has spends more than other countries on healthcare with worse results"?
I frequently hear the argument the US healthcare system needs to radically change because we spend so much more than other high-income countries with equal if not worse health outcomes for the general population. They bring up US life expectancy (US is around 78 vs. 80+ in other first world countries), infant mortality rates (5.8/1000 vs 3.6/1000), obesity rate, comparable survival rates from heart disease, cancer, etc. equally if not more prevalent mental health issues coupled with higher... Best way to counter "US has spends more than other countries on healthcare with worse results"? (Source: Student Doctor Network)
Source: Student Doctor Network - December 26, 2019 Category: Universities & Medical Training Authors: johnfree7 Tags: Topics in Healthcare Source Type: forums

Is the word 'obese' a slur?
I'm not trolling. I saw this very topic brought up on social media with someone describing the term obese as a slur even if it is a medical term. I'm looking for input perhaps from some docs who have had to have difficult discussions with patients about weight. Did you use the term obese? Is there any other way to address someone that is considerably large in size? (Source: Student Doctor Network)
Source: Student Doctor Network - December 24, 2019 Category: Universities & Medical Training Authors: justalittlestar Tags: Topics in Healthcare Source Type: forums

Tachycardia with stimulant? When to discontinue?
Hi, CAP fellow here. I have a 7 yo kid who I inherited from another doctor with a history of PTSD, ADHD and Intermittent Explosive Disorder. He's been on many different antipsychotics in the past due to behavioral outbursts. I have him on Focalin XR 20 mg qAM and Focalin XR 5 mg qNoon (insurance does not cover IR for reasons beyond me), Clonidine 0.1 mg qHS and Abilify 2 mg qAM (he was on a higher dose before but trying to lower as he is quite overweight). At any rate, the parent has been... Tachycardia with stimulant? When to discontinue? (Source: Student Doctor Network)
Source: Student Doctor Network - December 4, 2019 Category: Universities & Medical Training Authors: shahseh22 Tags: Psychiatry Source Type: forums

On questioning the association of weight loss with increased mortality risks among obese people from middle to late adulthood
(Source: BMJ Comments)
Source: BMJ Comments - November 18, 2019 Category: General Medicine Source Type: forums

Fever and undifferentiated abdominal pain - WWYD?
What would you do in this situation? 60 year old obese female with hypertension and hyperlipidemia comes in with a week of upper abdominal pain radiating into the chest and back, with lightheadedness, and today she developed a fever. No rash, cough, vomiting, diarrhea, blood in the stool or urinary symptoms. No recent travel or exposure to ill contacts with similar symptoms. History of a cholecystectomy and appendectomy years ago. No other surgeries. Initial vitals include a temperature of... Fever and undifferentiated abdominal pain - WWYD? (Source: Student Doctor Network)
Source: Student Doctor Network - November 6, 2019 Category: Universities & Medical Training Authors: ERCAT Tags: Emergency Medicine Source Type: forums

Re: Calorie labelling to reduce obesity
(Source: BMJ Comments)
Source: BMJ Comments - November 5, 2019 Category: General Medicine Source Type: forums

Metabolic medicine?
I read that chemical pathologists can specialize in metabolic medicine. I just stumbled accross this yesterday and found it quite intriguing My questions are: What do you guys treat and do, typical work and patient contact? All I hear its a relatively newer subspecialty and that they can treat any metabolic manifestations and are involved in parenteral nutrition. There's a fair amount of lab and patient contact which sounds cool. Involved in treating diabetes, hypertension, obesity... Metabolic medicine? (Source: Student Doctor Network)
Source: Student Doctor Network - October 11, 2019 Category: Universities & Medical Training Authors: Tman507 Tags: Pathology Source Type: forums

OBESITY AS A PUBLIC HEALTH EMERGENCY: A LOOK AT THE ‘Pre-FOAD HYPOTHESIS’ AS A PANACEA FOR THE ‘INTERVENTIONAL INEQUITY’
(Source: BMJ Comments)
Source: BMJ Comments - October 5, 2019 Category: General Medicine Source Type: forums

Re: Obesity is a public health emergency
(Source: BMJ Comments)
Source: BMJ Comments - October 2, 2019 Category: General Medicine Source Type: forums

Genicular RFA. Any input helpful!
hey all, I’m doing a significant amount genicular RFA with mixed results. Mainly in patients who are non-surgical candidate with severe knee osteoarthritis, morbid obesity etc. I work in the hospital when I started they already had coolief so I have been using that exclusively. Used it in fellowship. based on the Franco cadaver study, the superior medial and superior lateral Lie in the 50th to 75th percent depth of the distal femur, So I do two lesions at the sites (even with cooled), one... Genicular RFA. Any input helpful! (Source: Student Doctor Network)
Source: Student Doctor Network - September 20, 2019 Category: Universities & Medical Training Authors: thecentral09 Tags: Pain Medicine Source Type: forums

OB Case
Starting the night shift and this case came in 2 hours prior to my arrival: 25 yo G1P0 @ 39 week gestation, BMI 77, 210 kg, admitted for attempted IOL for fetal macrosomia and super morbid obesity. PMH: - Likely OSA, PSG scheduled in 3 weeks. Can lie flat and breathe comfortably if awake but sleeps on side at night due to waking up from obstruction. Worse since pregnancy. - Mild intermittent asthma, uses inhaler 1-2x every 2 weeks. Worse since being pregnant. - Chiari 1 malformation dx'd 2... OB Case (Source: Student Doctor Network)
Source: Student Doctor Network - September 12, 2019 Category: Universities & Medical Training Authors: ethilo Tags: Anesthesiology Source Type: forums

Inflated expectations of reduced obesity prevalence result from an erroneous static weight loss model
(Source: BMJ Comments)
Source: BMJ Comments - September 9, 2019 Category: General Medicine Source Type: forums

Re:Re: Quantifying the impact of genes on body mass index during the obesity epidemic: longitudinal findings from the HUNT Study
(Source: BMJ Comments)
Source: BMJ Comments - September 5, 2019 Category: General Medicine Source Type: forums

Re: Should obesity be recognised as a disease?
(Source: BMJ Comments)
Source: BMJ Comments - August 7, 2019 Category: General Medicine Source Type: forums

The affect of stress and lack of sleep on health of people in medicine?
The research on how much poor/lack of sleep + stress can affect the body and increase your risk of multiple types of diseases (dementia, cancer, metabolic syndrome, etc) are vast and well supported. Today, this thought hit me hard when I thought back about how many of my friends in med school have become overweight with a beer gut, getting into the territory of anorexia, or worsening health status. I can only imagine how much residency can negatively affect your health and appearance. Is... The affect of stress and lack of sleep on health of people in medicine? (Source: Student Doctor Network)
Source: Student Doctor Network - August 4, 2019 Category: Universities & Medical Training Authors: studentxx8800 Tags: Medical Students - MD Source Type: forums

Classifying obesity as a disease could reduce stigma
(Source: BMJ Comments)
Source: BMJ Comments - July 29, 2019 Category: General Medicine Source Type: forums