# 700 Lb man.



## exodus (Jun 20, 2009)

So everday we go pick up this same man.... 700*+* lbs. he seems to get bigger every time. Thing is, he is semi-ambulatory and really doesn't need an ambulance, but somehow his Dr. got him a lifetime PCS signature.  So every night around 1850 and every morning around 0500, we pick him up for dialysis and take 2 crews OOS for about an hour and half....

I hate people like that.

Also, he's not on O2, or anything like that, sooooo. yeh.


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## WannaBeFlight (Jun 20, 2009)

Yeah, those patients are tough, but his insurance is footing the bill. Better than not getting paid at all for your work.


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## Chelle (Jun 20, 2009)

Get a new career.

heh-heh....I kid you.  I kid.


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## Aidey (Jun 20, 2009)

If hes a dialysis Pt he is automatically on Medicare and Medicaid, so I would say we are all paying for it. 

I'm surprised that he attends dialysis 5 days a week, especially nocturnal dialysis. And that he hasn't had home dialysis arranged.


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## daedalus (Jun 20, 2009)

My company would refuse to take such a call. I would refuse such a call. Unless it was an emergency.


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## Sasha (Jun 20, 2009)

daedalus said:


> My company would refuse to take such a call. I would refuse such a call. Unless it was an emergency.




Why? If it's IFT and you work for an IFT company, it's your job.

Patients don't cater to you or your comfort. Perhaps he requires monitoring for something that exodus is unaware of and should go ALS? Who knows? And who knows why he is obese? It's not always sloth and gluttony.


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## HotelCo (Jun 20, 2009)

exodus said:


> So everday we go pick up this same man.... 700*+* lbs. he seems to get bigger every time. Thing is, he is semi-ambulatory and really doesn't need an ambulance, but somehow his Dr. got him a lifetime PCS signature.  So every night around 1850 and every morning around 0500, we pick him up for dialysis and take 2 crews OOS for about an hour and half....
> 
> I hate people like that.
> 
> Also, he's not on O2, or anything like that, sooooo. yeh.



He's on dialysis everyday? Just because he isn't on O2 or "anything like that" doesn't mean that he doesn't have other medical problems.


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## B.K. (Jun 20, 2009)

i agree with hotelco

if somebody is at the hospital everyday, there is something definitely wrong.
and i'll bet he doesn't want to be taking the ambulance every morning and night. not to mention its probably hard to get around town when you weigh 700lbs.


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## silver (Jun 21, 2009)

exodus said:


> So everday we go pick up this same man.... 700*+* lbs. he seems to get bigger every time. Thing is, he is semi-ambulatory and really doesn't need an ambulance, but somehow his Dr. got him a lifetime PCS signature.  So every night around 1850 and every morning around 0500, we pick him up for dialysis and take 2 crews OOS for about an hour and half....
> 
> I hate people like that.
> 
> Also, he's not on O2, or anything like that, sooooo. yeh.



sounds like this man is in end-stage renal failure if his doctor did this...could be on a transplant list
and its medicare only


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## fortsmithman (Jun 21, 2009)

With the service I belong to for this type of call we would get a FD assist.


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## Aidey (Jun 21, 2009)

Of course he's in end state renal failure, that is why he is on dialysis. What is unusual about the situation is the fact he does dialysis more than 3 times a week. 3 treatments is by far the most common number of times people need dialysis a week. People who are non-compliant with their diet/medications and fluid restrictions may occasionally need an extra treatment, but 5 days a week, every week is very unusual. 

Especially since he's on nocturnal dialysis, which is longer than the standard treatment (which is usually 4 hours).  With a longer treatment they can remove more fluid than would be removed in 4 hours.

There is also almost no way on earth he is on any sort of public transplant list, at least not as an active recipient. Transplant lists have weight/BMI restrictions to maximize the chance of a successful transplant. pts also can't have a number of other issues/conditions, and they can't smoke.


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## silver (Jun 21, 2009)

Aidey said:


> Of course he's in end state renal failure, that is why he is on dialysis. What is unusual about the situation is the fact he does dialysis more than 3 times a week. 3 treatments is by far the most common number of times people need dialysis a week. People who are non-compliant with their diet/medications and fluid restrictions may occasionally need an extra treatment, but 5 days a week, every week is very unusual.
> 
> Especially since he's on nocturnal dialysis, which is longer than the standard treatment (which is usually 4 hours).  With a longer treatment they can remove more fluid than would be removed in 4 hours.
> 
> There is also almost no way on earth he is on any sort of public transplant list, at least not as an active recipient. Transplant lists have weight/BMI restrictions to maximize the chance of a successful transplant. pts also can't have a number of other issues/conditions, and they can't smoke.



Of course you know people temporarily can go on dialysis for acute renal failure which is not end-stage; at least be right...

this may be assisted peritoneal dialysis (assisted because of limited mobility), which would make sense because it is daily, but normally happens more than twice a day. Maybe someone assists him at home during the day. However I am not sure.


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## Aidey (Jun 21, 2009)

It's still renal failure, which is the point I was making. 

I doubt it about the PD, if it was assisted peritoneal a nurse would most likely go to his home and help him change out the fluid, and hook up the circulator. He wouldn't need to be transported to a dialysis clinic. Peritoneal dialysis doesn't require the supervision that hemo does.


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## gicts (Jun 21, 2009)

silver said:


> sounds like this man is in end-stage renal failure if his doctor did this...could be on a transplant list
> and its medicare only



A 700 pounder on the receiving end of a transplant list? I guess I've seen stranger...


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## exodus (Jun 21, 2009)

oops, that's what i get for not being 100% clear. The pt only goes on 3 days of the week, which happena to be the days i'm on. so "every day" for me.

only other underlying problem is diabetes, which is caused by the weight.


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## VentMedic (Jun 21, 2009)

Aidey said:


> If hes a dialysis Pt he is automatically on Medicare and Medicaid, so I would say we are all paying for it.
> 
> I'm surprised that he attends dialysis 5 days a week, especially nocturnal dialysis. And that he hasn't had home dialysis arranged.


 
His size and probably the reasons he needs dialysis 5 days per week do not make him a candidate for home dialysis.

No, it is not uncommon for some patients to need dialysis more frequently especially if there are cardiac or volume issues involved.  To pull too much fluid off of a person this size could be deadlly.  Thus, he needs close monitoring.  We may also have patients on dialysis 7 days a week for a month or two and stay in a SNF while receiving it because they still need monitoring.   We also have patients on dialysis continuously for many days or weeks in the ICUs.   

Renal failure is usually NOT an isolated disease.  It is the result of a much bigger problem that has shut down or overwhelmed the kidneys.  There may be extensive damage to other organs as well.  Thus, a transplant would probably not be a choice.   Again I will stress, these are probably the sickest patients one could transport and yet some just know the "renal failure" part of their diagnosis and not much more than that.  If they did,  EMT(P)s probably would not have these discussions to poke fun or criticize dialysis patients.  

What is with the attitudes here that some of you now believe you have the right to determine who lives or dies and who is worthy of Medicare, Medicaid or MediCal?   



> only other underlying problem is diabetes, which is caused by the weight.


 
Do you know that for sure that the diabetes was caused by his weight? Skinny people can also get diabetes.  That would be one of the problems that is being treated.  How long has he been a diabetic and what contribution did it have in his kidney disease?   What about his EF?  What was the initial cause for dialysis?    There could be other problems that are treated by the dialysis which is why the content of the dialysis fluid and amount fluid pulled off may vary from day to day.


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## Aidey (Jun 21, 2009)

The OP corrected his statement, and the pt is only on dialysis 3 days a week. I'm aware that some people may require longer periods of dialysis, but as you pointed out, they are generally in SNFs or the ICU, not being moved from their home to a clinic every day. In the context of the story (a guy being moved from his home to a out pt dialysis clinic) nocturnal dialysis 5 days a week is unsual. I wasn't saying it was impossible in any situation, but with the information we had, it was an unusual situation. 

To pull too much fluid off anyone can be deadly, regardless of there size. Anecdotally I would say larger people tolerate dialysis better than smaller people when it comes to pulling large volumes of fluid off and complications like low blood pressure, cramping etc. Granted we never had a pt that was 700lbs, but we had several in the 300-400lb range. There were also some people who absolutely couldn't tolerate more than 3L in a 4hr treatment even if they had 8L on. There were others that tolerated 5L without any issue. 

I also want to mention that in an outpatient clinic setting dialysis Rxs are not changed that frequently most of the time. By the time we get 99% of our pts they have already had dialysis in the hospital for at least a week or two, and there Rxs were refined there. Depending on how a new pt was tolerating the tx we would occasionally do weekly labs, but as far as I know we never once had a pt that had labs with every single treatment. 

I think the whole point of this thread was that it's a pain in the butt to move a 700lb pt 6 times a week for any reason (6 because you have to move him in and out). It wasn't about poking fun at the dialysis, we just got diverted when a few of us observed his dialysis RX was unusual.


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## VentMedic (Jun 21, 2009)

Aidey said:


> I also want to mention that in an outpatient clinic setting dialysis Rxs are not changed that frequently most of the time. By the time we get 99% of our pts they have already had dialysis in the hospital for at least a week or two, and there Rxs were refined there. Depending on how a new pt was tolerating the tx we would occasionally do weekly labs, but as far as I know we never once had a pt that had labs with every single treatment.


 
Most dialysis centers are outpatient. Your center may not handle high acuity patients but for those that do we can regulate their Rxs as needed with lab results obtained from the previous visit. Yet, we have only a relatively small center that handles about 120 patients per day. Just the inpatients wouldn't pay the electric bill. 



Aidey said:


> I think the whole point of this thread was that it's a pain in the butt to move a 700lb pt 6 times a week for any reason (6 because you have to move him in and out). It wasn't about poking fun at the dialysis, we just got diverted when a few of us observed his dialysis RX was unusual.


 
Do you know how many times that patient might be moved by just two hospital or SNF staff members? We see a lot of bariatric patients since we are a surgical center that can handle patients of that size and risk.

With the new stretchers on the ambulances, this should not be that big of an issue even if he is large. Taking care of patients is not always about the glory and glamour.


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