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Among Giants; Courageous Stories of Those Who Are Obese and Those Who Care for Them
Among Giants; Courageous Stories of Those Who Are Obese and Those Who Care for Them
Among Giants; Courageous Stories of Those Who Are Obese and Those Who Care for Them
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Among Giants; Courageous Stories of Those Who Are Obese and Those Who Care for Them

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Among Giants offers profound insights into the lives of those who battle to achieve success over adversity. Sometimes the struggle is spiritual, physical and sometimes the struggle is discrimination or failed support systems. Readers will laugh and cry. Among Giants is a must-read for anyone who works with or is a person of size.

Among Giants articulates life lessons to a world often blinded by negative views of people of size. Never before has a complex health and social issue been so relevant for such a unique patient population. The subject is a front-page story: An evolving healthcare industry is scrambling to meet the needs of the fastest-growing patient population in history. Amazingly frank and positive, Among Giants expresses the humor and spirit demonstrated by so many patients of size.

Dionne’s Bariatric Body Types identifies predictive mobility patterns within each body type based upon cardio-pulmonary tolerance and mass distribution. Diversity is expressed as Apple Pannus, Apple Ascities, Pear Abduction, Pear Adduction, Gluteal Shelf, Posterior Adipose within two appropriate phases of care.

Failure to respect that greater diversity exist within the population of size can lead to misguided technique and catastrophic consequences for both the patient and caregiver.

This book features:
Dionne’s Egress Test
Performance Triad
Dionne’s Bariatric Body Types

Michael Dionne, founder of BariatricRehab and Choice Physical Therapy, Inc., located in Gainesville, GA, specializes in the care of dependent patients of size. Mr. Dionne has consulted throughout North America, Australia and in Europe. To date, he has worked with clients up to 1200 pounds.

LanguageEnglish
Release dateAug 28, 2011
ISBN9781465981301
Among Giants; Courageous Stories of Those Who Are Obese and Those Who Care for Them
Author

Michael Dionne

Michael Dionne, founder of BariatricRehab and Choice Physical Therapy, Inc., located in Gainesville, GA, specializes in the care of dependent patients of size. Mr. Dionne has consulted throughout North America, Australia and in Europe. To date, he has worked with clients up to 1200 pounds. He was awarded the Mary Pat Murray Award for "Clinical Excellence." He was a finalist for the Health-Care Heroes Award in Atlanta in May 2000. He is an active member of the American Physical Therapy Association, National Association of Bariatric Nurses, American Society of Bariatric and Metabolic Surgery and has numerous professional publications and international presentations including the National Association of Bariatric Nurses and American Society for Bariatric Surgery to his credit. In 2002, he was awarded Marquette University's "Physical Therapist Alumnus of the Year" for his distinguished work in the care of the patient of significant size. He has been an invited speaker for 5 American Physical Therapy Association's National Conferences. In 2006, Mr. Dionne presented to the National Institutes of Health (NIH).

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    Book preview

    Among Giants; Courageous Stories of Those Who Are Obese and Those Who Care for Them - Michael Dionne

    Among Giants

    Courageous Stories of Those Who Are

    Obese and Those Who Care for Them

    SMASHWORDS EDITION

    * * * * *

    PUBLISHED BY:

    Michael Dionne, PT on Smashwords

    Among Giants: Courageous Stories of Those Who Are Obese and Those Who Care for Them. Copyright © 2006 by Michael A. Dionne, PT

    All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form, or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of both the copyright owner and the above publisher of this book.

    Smashwords Edition License Notes

    This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each person you share it with. If you're reading this book and did not purchase it, or it was not purchased for your use only, then you should return to Smashwords.com and purchase your own copy. Thank you for respecting the author's work.

    Michael Dionne, PT

    Choice Physical Therapy, Inc.

    www.Bariatricrehab.com

    There is no greater gift than to assist another in achieving success over adversity. 

    Michael Dionne, PT

    Among Giants may be purchased for educational, business, or sales promotional use. For information, contact:

    mdionne@bariatricrehab.com or call (770) 532-4327.

    Library of Congress Cataloging-in-Publication Data

    Dionne, Michael.

    Among Giants: Courageous stories of those who are obese and those who care for them / Michael A. Dionne.—1st ed.

    Includes sources and resources.

    ISBN 978-1-4303-0945-1

    Diet/Health. I. Title

    Acknowledgments

    I would like to thank the many people in health care, in hospitals, in nursing homes, and elsewhere, with whom I have worked as a physical therapist and consulting caregiver, for the opportunity to learn about the challenges and triumphs of those of significant size. I would especially like to thank those courageous souls of size whose amazing qualities and positive spirit teach us all so much.

    I would like to thank my colleagues who have inspired me in my career and life. I am thinking particularly of the members of the Wisconsin Judo Association, Marquette University Staff and Associate Professor of Physical Therapy at Marquette University, Dennis C. Sobush, who always encouraged the exercise of creativity, even in the most complicated of clinical scenarios.

    I would also like to express my appreciation to my eight year old daughter, Katie Rose, who accepts other children readily and who reminds me why we need sensitivity to interact positively where there is diversity.

    I must include a very special thank you for my mother, Margaret Rose Dionne, who is a retired nurse, and my sister Peggy Ann Dionne, RN, for whom I am thankful for their love and encouragement. Lastly, I would like to thank my wife who has, through her intelligence and patience, encouraged my ideas and approaches; affectionately special thanks Nancy Sturtevant.

    Additional thanks for their assistance in creating the fictional character maps, Mark Graham and our researcher John Nance of Mark Graham Communications. I would strongly recommend the great people of WordTechs Writing Services for their fine assistance in bringing the final promise of this book to reality.

    Finally, I'd like to thank Audie Murrell for the outstanding illustrations included in this work.

    Foreword

    Among Giants is a series of fictional stories created to articulate life lessons to a world often blinded by negative views directed toward those of significant size. No real names, locations, or scenarios have been used. The stories have been created to express events that occur in any city in any country. I remind the reader to respect that there are striking similarities experienced by persons of size in actual falls and injury-related scenarios and to respect that the depictions in this volume are fictional. The hope for this book is to expand the current view of those of size and reveal the true diversity that exists within the population of size. By identifying the failings of health care providers and humanizing those within the population of size, I hope to improve their overall care and management. Never before has a complex health and social issue been so relevant for such a unique patient population. The subject should be a front-page story.

    My purpose is to articulate the challenges and accomplishments of both those of significant size and their health care providers. The goal is to provide authoritative information concerning many aspects of bariatric rehabilitation and well-being. Among Giants addresses the primary considerations in accommodating obese patients, getting such patients mobile, and providing emergency medical procedures. It is presented in understandable (but not oversimplified) language. For the lay reader, Among Giants defines complicated medical terms clearly and concisely. Anyone can learn to recognize, respect, and better understand the problems faced daily by people of size. The book will help families and friends to work in conjunction with nurses and doctors in providing the best care.

    Each chapter employs a fictional character to express the physical challenges unique to those of size. The text includes Dionne’s Bariatric Body Types (first written in 1992) and an explanation of the Performance Triad. The chapters take each fictional character through the complexities of the health care system and dynamics of care that present physiological and social implications in a thoughtful and meaningful presentation. At the conclusion of each chapter, there is a lessons learned segment that provides discussion specific to each case.

    Historically, intervention for the patient of size taxed the ingenuity of nurses and therapists. The caregivers had to solve problems through innovation and fabrication, as they did to manage the traumas of wars or epidemic outbreaks such as polio. Among Giants is a source of current information on morbid obesity, with a review of problem areas in a readable, fictional, case-study format. I provide a unique view of diversity within the population of size by explaining a new system of body type classification that describes acuity of treatment phase in great depth with practical advice for those who are new to the field. For the general interest reader, it addresses the specific psychosocial issues that compromise wellness in patients of size and the multiple disorders that can affect intervention.

    Anyone who knows a person of size, works with those of size, or intends to become involved in the health care industry will benefit from this incredible resource. The people they care for will thrive as well. Among Giants also speaks directly to our American culture, a culture rapidly moving toward a population growing in size. It discusses what the individual can do to elevate their heart rate and calm their mind, thereby elevating our culture’s metabolic set point toward greater activity and greater health.

    I have devoted over sixteen years to bettering the care of the population of size. In the late 1980s, I was asked to help a fellow physical therapist in the evaluation of his first patient of very significant size: a man of over 1,000 pounds with the cognitive capacity of a four-year-old. That was the beginning of a journey that would take me all over the United States, Canada, and Europe, to redefine safe management techniques for people of size, culminating in the formation of Choice Physical Therapy, Inc., founded in 1992. I know bariatrics like no one else, and today, I travel internationally to assist healthcare facilities get patients of all sizes to become mobile again. I revolutionized therapeutic grips and the use of mechanical mobilization to meet the needs of the person of size. I have devoted my knowledge and experience to this unique population and am dedicated to helping the healthcare community improve their quality of service to persons of size while creating a safer work environment.

    Chapter 1. The Consequences of Size

    As a physical therapist, I have worked with many people who weigh up to 1,000 pounds. In each case, I have had to modify techniques to successfully mobilize those of significant size that are dependent. In the beginning, the challenges surprised me, and the patients often impressed me. Many of the stereotypes that I had anticipated quickly melted away in the motivation of the moment and the heroic battle for independence many of these individuals waged.

    Now, almost twenty years later, I am convinced that the typical medical view of the diversity within the bariatric population is far too limited. In fact, I find that I very rarely think in the typical medical jargon of bariatrics or obesity in my work; and, when I do, it is specific to equipment. I rarely use the word obesity. I usually refer to a patient who weighs up to 500 pounds as a person of size. For those between 500 pounds and 1,000 pounds, I use the term person of significant size. For me, the phrases have evolved since early 1991 from contact with actual patients. These patients simply did not feel comfortable with the traditional jargon. Many persons of size have been subjected to a cultural stigma and negative view of obesity. The new wording seems to work well and is meant to be respectful. Some patients feel uncomfortable with being classified as bariatric, fat, big, or obese, and with the names of related equipment, such as Big Boy Beds. Therefore, it worked out that reference to size and significant size became the most uncontroversial means to discuss and minimize the risk of offence associated with typical jargon. This helps establish a positive patient rapport.

    I believe many more people of size fight for independence than the media portrays. The daily news is dominated by the negative health aspects of size and rarely portrays a heroic, personal story unless it is related to surgical intervention or medicine. We need to bring the individual patients back into the focus.

    Once, I attended a conference where a presenter made reference to the Bariatric Personality, and presented classes based upon the management of this categorization. This approach is an oversimplification of a group and does a huge disservice to individuals within the population of size. To generalize the entire population of size as being typified by anxiety and depression is an inaccurate and stereotypical depiction. It would be a great deal more accurate to identify that anxiety, depression and inappropriate coping mechanisms dominate where people are weak relative to body mass and are found to be common for those individuals who are dealing with multiple medical complications, rather than to suggest these psychological issues are a characteristic present in the entire population of size. There are at least as many people of size who are independent, fully-functional, well-adjusted, with very affectionate relationships, and who do not exhibit the negative characteristics too often attributed to size.

    Clinicians who work with the population of significant size quickly learn that many of these individuals have been business owners or hold advanced degrees and often have above average intelligence. I am seeking to avoid a care environment that trivializes the individual and generalizes the health care intervention.

    When a health care worker treats a patient known to have anxiety or depression in the average size population, the caregiver should finish his work professionally and leave the room without dwelling on it. The visit should remain confidential. When an untrained health care worker walks into a room and is presented with a patient of 850 pounds who happens to have the same level of anxiety or depression, the caregiver rarely behaves professionally. Too often, upon initial contact, the caregiver’s gaze is directed to the patient’s spread. As a result, the caregiver will bury his face into his clipboard feeling at a loss as to what to do and will even forget to introduce himself to the patient. Most patients look directly at the eyes of the caregiver as the caregiver enters the patient’s room. The caregiver’s misguided glance and awkward indecisiveness may be perceived by the patient as judgment. This is the vital moment where any chance at developing a rapport is lost, and communication becomes forever compromised. This negative first impression may perpetuate itself as it is reinforced by other insensitive caregivers for years to come. Too often, the untrained caregiver struggles to complete the task and leaves the room frustrated and inadequate. The untrained caregiver is not physically adequate to mobilize or care for the patient. As he walks down the hall seeking help from co-workers, the stereotypes walk with them. Did you see that patient in room 232? What am I going to do? The caregiver broadcasts his frustration and inadequacy at the nurse’s station. The nurse’s station is an open public forum where any bystander can get an earful of unprofessional demeanor.

    This patient weighs 850 pounds, and I’m 130 pounds. How do they expect me to get this patient up four times a day? Can you believe this order, who do they think I am, Superman or something? What the heck am I going to do?

    Many lawsuits have derived from far less harmful public displays of confidential patient information. When caregivers get sloppy with confidentiality, many negative consequences can occur. Beyond litigation, the media could get involved. I have performed charity visits and found staff members who have traveled across the medical campus just to sneak a look into the patient’s room. This was disrespectful conduct, a violation of patient privacy and a potential cause for a hostile environment for the patient. These problems can be prevented with training in patient confidentially.

    Thankfully, with the development of new medical equipment and sensitivity programs, healthcare workers have become empowered to provide better care for patients of all sizes. The equipment gives us the physical adequacy to defeat the stereotype. When a caregiver has been trained in the correct use of bariatric equipment, the awkward moment of a misguided glance and overall inadequacy can be eliminated.

    The Bariatric Triad refers to the minimal equipment required to safely manage the patient of size. It includes the starting surface, like a weight-rated bed, a lift and a target surface such as a wheelchair. (1) When the minimal equipment is combined with sensitivity training, a powerfully positive environment is created where miracles can happen. With training and equipment, the caregiver is empowered because they have a plan to offer to the patient. There is no excuse for pause and inadequacy where there is potential to act positively toward success.

    Since 1992, I have performed as many as five sensitivity and safety programs in a single week and 150 programs in a single year. In one of our earlier programs, I recall talking to a group of about 200 nurses at a convention. We were on the topic of patient rapport when, for the first time, I thought to ask the audience: How many of you have witnessed another professional use harsh or degrading language toward a particular patient? Almost all the hands in the room went up. Then I said, Wow! That says a lot. Is there anyone here who has never seen degrading language used toward a patient, because I want to work where you work! No hands went up. We all had a laugh over that. It is a segment I continued to use in my talks, and the results are consistent -- nearly always 100% of respondents have witnessed another professional using harsh or degrading language toward a patient.

    Obviously, healthcare workers are better than this test demonstrates; however, it does raise an interesting point, which the following story illustrates. I was working with a patient who was referred to therapy directly from the emergency room demonstrating a very significant self-care deficit. The patient had spent a number of weeks in a sleeping bag and did not come out for any reason, which resulted in terrible skin compromise. This client was transferred directly from the emergency room to the hydrotherapy department while still undergoing emergent management for acute heart failure. This required a large whirlpool tank, and the ER was not equipped. The initial task of removal and disposal of the sleeping bag was accomplished and a final rinse of the patient was completed. The patient was then draped in blankets and an area was identified as needing immediate treatment. The area itself was prepared for initial debridement and dressing.

    During the process, we witnessed an interesting transformation in the patient’s personality. The patient began to open up and started to talk to us, providing valuable feedback. The clean blankets and gown changed everything for this patient. We were learning about his family and support systems, and the outlook became increasingly positive. We were completing the wound care process when the lead resident stomped into the hydrotherapy room without a knock and with the door left wide open behind him. He tossed the patient’s chart onto a table, missing badly. The result was that the chart fell to the floor, breaking open with pages sprawled about the damp floor. He proceeded to rip verbally into the patient, What’s the matter with you? Why are we wasting health care dollars on you? You are not worth my time. How much time am I going to waste walking up here when I could be helping people who deserve it? My time would be better spent playing golf! He left, slamming the door, while we had our hands full of gauze. The patient retreated into mute silence.

    The damage accomplished in such an interaction cannot be measured. Degrading language may work on the field of play for some, but in the clinic of real life and especially for those with psychological sequela, degrading language is doomed to failure. When that doctor walked out of the room, he not only left us with a mess on the floor, which took time away from patient care, but he also destroyed a tenuous rapport for anyone in a white coat. The patient stopped talking but communicated a larger-than-life message in silence.

    Regardless of how much you try to have a positive interaction, when an event is followed by a negative interaction, the patient rapport will be sabotaged. As a healthcare provider, I would always be associated with that one doctor. In fact, for that patient and the related family, every healthcare provider or person bearing a white coat will be associated with that negative event. It is no wonder some patients avoid honest interaction. Degrading language and negative behavior by a professional has never improved the behavior of a patient demonstrating a profound baseline self-care deficit. So why do it? Perhaps negative behavior by a professional has more to do with the professional who is directing the assault than it has to do with the patient. The consequence of degrading language is diminished communication with the patient and the patient’s family and a subsequent prolonged length of stay. It undermines cost effective progression of the patient to the next level of service.

    This is not a discussion to promote an inflexible, politically-correct work environment. Rather, the discussion is to drive home the point that the cost of a negative care environment affects us all. Negative conduct results in increased cost for everyone. It is odd how some professionals can so fully understand that the use of degrading language toward a patient who has a diagnosis of Alzheimer’s serves no purpose, but on the other hand demonstrates little respect for those with other identifiable psychological propensities.

    I recall a question posed by a nurse at a recent conference. She asked, Why can’t we use degrading language about a patient behind closed doors? I was bit surprised by the question. It was entirely innocent, but still points to a larger issue among some caregivers. I responded, You are free to say whatever you want behind a closed door, but ultimately whether you are positive or negative reflects upon you.

    Patients will judge whether or not a person is sincere. When a caregiver trashes a patient in a conference or lunch room discussion and then walks into the patient’s room with a fake smile and phony façade, it is obvious to the patient. Most patients are very perceptive and are able to detect insincerity. A positive work environment is needed in health care to move the patient to the next level of care in the most cost-effective manner. That can only be done when the providers are sincere.

    As nurses and therapists all know, a good rapport is everything. Many support personnel become masters in achieving a good rapport when working with their patients and are able to accomplish miracles -- tasks that the credentialed professional could not. We must reinforce the value of every member of the health care team as well as the value of a positive approach.

    The De-Activated Society and Stereotypes

    For many professionals obesity is still simply a behavioral disorder. The behavioral sciences began with the studies of Sigmund Freud, and collectively refer to psychology, sociology, and anthropology. They derive their theories and methods from the study of the behavior of living organisms. Human behavior has been studied closely since that time. However, obesity as a pandemic explosion has statistically existed only since about 1990. Obviously, there is more to the accumulation of size than simply just behavior.

    Europeans are now starting to feel the effects of metabolically-suppressed environments. We recognized that if astronauts do not exercise while in space, they will lose muscle mass and bone density. While in the weightless environment, cardiac output and pulmonary function can become so weakened over time that severe sickness and potential system collapse can result. Resistive exercise is required of the astronauts if they are to survive. As technology progresses to a level where it dominates our lives, we must change our culture to include activity in our daily lives to elevate our heart rate. The consequences of inactivity are catastrophic.

    Compare the lifestyle of a 1960s child to that of a child of the new millennium. When I was a kid if I wanted to play, I would grab a bunch of my dad’s tools and screw some roller skates to a plank and call it a skateboard. Today’s kid slides a CD-ROM into a computer and uses a mouse and video game to occupy his time. If my father wanted to change the TV channel, his only remote was me. I had to get up from the couch, make my way over to the TV, and turn that big knob that changed the channel. It was a task that took two hands that often left marks on my skin. That was on a good day. If the knob was broken, then I had to get the old pliers to turn the metal nub that remained. Because I walked across a wool carpet, I was charged with electrons; and, upon contact, I got zapped. After I fell to the floor in heart arrhythmia, my dad would run over and grab the old rabbit ears antenna, plug it into the wall socket, and touch the antenna to my chest and perform electric cardioversion. I survived, never mind a little smoke rising from my chest. To minimize the static on the TV screen, Dad would direct me to run around the room with the rabbit ears antenna balanced on my head.

    Admittedly, it is a relief not to run around the room with the rabbit ears anymore, but the point is that currently we are not burning calories in even the most basic activities. Too many children sit on the couch with an infrared remote and surf 200 channels succumbing to a blank expression and depressed brain activity. We are deactivating our society with video babysitters. As a kid, I played on monkey bars, swing sets, merry go rounds and horizontal bars that were built on cement. If you fell, you split your head open. The teacher simply told you to tuck your brain back into your head and get back into school. Our slides baked in the sun all day, and you fried your backside on the way down or jumped off the side, breaking an ankle. Today, a child uses a slide made from tubing where falling is not possible. The greatest fall is about twelve inches into soft wood chips.

    When I was a kid crossing the city of Milwaukee on a bus in 1970s, you could hear the sound of construction workers using jack hammers and you could watch them working with their tools. Much of the work in digging was done manually and employed a shovel and pick axe. Now, construction workers have use of smaller powered backhoe devices that attach the jackhammer to a miniature bulldozer to do the work. None of us are burning calories anymore. The Segway ® is now on trial in postal districts and is anticipated to revolutionize efficiency in delivery. Obviously, the body weight of postal workers is going to explode when such energy efficient tools are employed.

    It is ironic that OSHA (U.S. Department of Labor Occupational Safety and Health Organization) and lawsuits instigated by injury claims are making working environments safer, but are resulting in depressed metabolic rates. It is not my intention to suggest that we should not maximize efficiency and safety in industry. We need to recognize that we are becoming trapped by our own technology and that it is killing us in terms of metabolic suppression and its ultimate consequences, like diabetes.

    Because of lawsuits related to falls on public steps, architects now create buildings that direct patrons to an escalator or elevator. If you can find the steps in a large building, often the walls are left bare and unpainted as they are so rarely used. The result, of course, is greater safety, but the consequence is a generation of people who very rarely take the stairs. It is amazing how many people in airports stand idle on the mobile walkways. They are great for those who need them; but, when you see an obese child drinking a large soda and standing idle on such a walkway, it begs the observer to ponder the implications of technology and diet as it relates to that child’s life expectancy. We need to rethink how we play and how we work.

    Another question I pose to American audiences is, How many of you believe Americans are lazy? Please raise your hands. Usually this will draw at least half of the participants in the room to raise their hands. I ask them, How many of you know a nurse or an aide who has worked a double shift? Almost all hands go up. How many of you know of someone who works a side job or two jobs to make ends meet? Again, about half of the hands go up. Then I ask, If you lived in France or Germany, how many hours would you be limited to work in a week? When I tell them the answer is 35 hours per week, my audience is usually shocked. They are equally surprised to hear that these people also receive as much as four to eight weeks of pure vacation annually. Because of the economic dynamics of employment in the U.S., most Americans are lucky to see more than one or two weeks of vacation in a single year. Americans simply work more hours than people in most other nations.

    I was asked once, What about that poor farmer pulling the grain out of the earth with his bare hands? I agreed that these people do work very hard, but compared to the average American farmer, it is no contest. He often works an eight hour shift in a factory or in construction then returns to his farm and jumps into a machine as big as my house and farms until two in the morning. He goes to sleep only to wake at six to do more chores so that he can be at work by eight. Farmers work an incredible number of hours in the U.S. as do many farmers in other countries; the difference is American farmers drive massive combines through the night while farmers in less developed countries often use manual technology and take their rest. The American farmer fills the cab of his air conditioned tractor with soda or coffee and snacks to stay awake to meet the day’s goal. We truly have a bit of a self-destructive work ethic in this country. We live to work.

    Recently, I stayed in Chicago to do a

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