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Sunday 6 May 2018

A 19-Year-Old Man With Life-Threatening Obesity. What treatment to apply? May 6. 2018

     Obesity. 19 years old boy. His weight is 192 lb (87 kg), which puts him in the 90th percentile, and his height is 51.2 inches (130 cm), which puts him below the fifth percentile. His body mass index (BMI) is 51.5 kg/m2. As it is usual, the obesity to blame. It is difficult to see that boy is unusually short. 19 years old boy just 130 sm. This is his severe obesity. If he was taller his BMI would be not so worry about. But he is short. Boy is in hospital. Take a look at the case. It is really interesting case. It is not my ball so I suggest to open link till it is working.
     I read comments, discussions. Many doctors suggest, roll out DM. He has elevated level of sugar in blood, but not so high. Really unusual for that severe obesity. He has elevated BP but not so high, and who does not have elevated BP? I had it since my teens. And he has sometimes very aggressive hunting for food. Not all the time, but on some specific moments.
     It is not diabetes type 2. It is  Prader-Willi syndrome, an estimated worldwide prevalence of 1:10,000 to 1:30,000. Really as one doctor posted, she met that case only once in her practice. The same as it was told about diabetes in past time. 19 years no one MD was able to diagnose what is the problem. At age of 15 boy stopped to go to school. He was bulled severely. Really, he is not handsome boy.
The diagnosis of Prader-Willi syndrome was based on the clinical features of a voracious appetite, gross obesity with short stature, disproportionately small hands and feet, and no signs of facial, axillary, or pubic hair.
Some MD suggested it is another disorders, and for 19 years he had different dignoses, treatment, but no one was effective.
It is a genetic disorder primarily caused by gene deletion on the paternal-inherited chromosome 15 in the q11.2-q13 region. Overall, three molecular mechanisms of Prader-Willi syndrome have been described: paternal 15q11.2-q13 deletion, maternal uniparental disomy (UPD) of chromosome 15, and imprinting defect. These mechanisms constitute 65%-75%, 20%-30%, and 1%-3% of cases, respectively. DNA methylation analysis is the technique used to diagnose PWS for all three mechanisms
Of cause, if this is obesity then work out and diet would have effect. Not at all.
No definitive treatment is available. Multidisciplinary surveillance is important to control symptoms and complications.
He was Rx Metformin for diabetes type 2, and reduction of obesity, diet and work out.
 Three weeks later, the patient developed respiratory distress and oliguria. He was admitted to a hospital and diagnosed with pulmonary edema. Oxygen support and diuretic treatment were initiated. Despite these interventions, his respiratory distress persisted. On day 4 of admission, the patient had a cardiopulmonary arrest and later died at age 19 years, 3 months.
        It is sad and painful case to discuss, and to read. 19 years old, all his life he was ill, and so severely bulled that he was not able to show his face to others. What most popular response to the case?
"So sad. If he was diagnosed yearly!" really? What treatment one can suggest? There is no treatment for this medical condition. It is possible to treat some symptoms such as skin condition, or elevated level of sugar. Edema usually treated with diuretics. It does not work. He could have dialyses to clean his blood because of kidney failure. I did not see that this treatment was applied to him. It is possible to reduce weight and probably this surgery could help him to live longer. No one work out or diet could help. Better to have surgery to reduce weight, plastic surgery. It is not considered to be medically necessary. Weight loss surgery is safe for people. Plastic surgery to reduce weight not paid by medical companies.
    People look at obese population with ignorance and aggression.  They have brine washed mind that it is all because of we do not care what and how much to put in out mouth. Really, we do not look at others they are stupid or simple ugly, too short or too long, too red or too green. Why we are so aggressively bulled just because of we ill? Let us live as we are. Mind your own business. Maybe  in school our kids would not bull other students and would not be bulled? Every one can do it. Just be patient, and nice to others, regardless how many pounds on our belly.

A 19-Year-Old Man With Life-Threatening Obesity
https://reference.medscape.com/viewarticle/894774?src=wnl_casechlg_180424_mscpref&uac=164666HZ&impID=1609503&faf=1


via Ravenvoron

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