What kind of medical condition does this man's legs have?

James K actually had heart failure for a little while.

It can't. What you see in the picture is the body coming undone.

Full episode for James K's story

youtube.com/watch?v=v831GUCkALQ&t=3850s

That is a textbook example of Laygs.

Oh I see, so it's actually dying.
Thank god.

Imagine having to bathe James K

What was the fluid that was leaking out of the wounds?

>helping to wipe your dad's ass
>your dad is James K
His daughter is going to have severe issues

it doesn't seem possible to get that fat

he obviously can't get his own food. you could easily reduce his caloric intake and he can't do shit about it

where is the humor in not giving him more food?

His girlfriend/caretaker gives into his demands and brings him anything he wants. She's basically murdering him. I think she wants him to die.

"Enablers"

A mix of peripheral oedema and hypoxia both exacerbated by being overweight.

That's my guess

Same guy, I just looked at the full-size image and saw the details. I haven't got a fucken clue.

Jesus fucking Christ

Massive bacterial infection and poor circulation is what I'm betting on.

would necrotizing fasciitis help his condition at all?

I'm pretty sure he already has enough skin infections. If you mean helping by killing him then maybe.

He would starve to death. You can't live on fat alone for long. You have to at least keep bringing him lean protein and vegetables (and water, of course) if you want him to survive the weight loss.

Venous stasis with chronic changes overlaid by a nice infection

This, fat people are typically very malnourished.

A pressure washer would be great to remove all that disgusting dead yellow skin.

>being so big people wash you like they wash a car

FATTIES OUT!
ncbi.nlm.nih.gov/pmc/articles/PMC2495396/

I'm no doctor (just a student)
But it's tough to tell for me looking at the pic (can't see the webm)

I assume they would need to rule out cellulitis, a CBC, ESR, CRP, and wound cultures (long shot) would provide some catalyst to start this guy on standard treatment (dosed vanco and clinda)
God knows his legs are a nydus for infection

Edema is a possibility, but would need a 2D echo to dictate a treatment. I'm kind of assuming the majority of his leg is just fat without palpable edema. A BMP would be helpful in assessing volume status.

I assume the fluid seeping is occurring through little breaks in his skin or some other open lesion? This I assume is just water following its natural course, through gradients and solute pressures, and water will gladly exit through these cracks if it's solute potential, soft physical pressures of turgid pressure, and room air conditions promote/expedite this occurrence.

The rubor color of his legs could be subsequent to many things though if it isn't cellulitis. The stocking appearance on his L leg, if he had some form of compressive wrap, the subsequent pressure could cause some hemoglobin to rupture and produce this rubor. Maybe some vascular component is at foot.

Regardless, this man needs to have a deep discussion with himself, and either elect a DNR status if he wants to continue this reckless lifestyle and just have home health care and hospice arranged down the line, chill at home, eat himself to the grave, or optimize his health to be a candidate for gastric bypass and make appropriate lifestyle choices.

He would essentially be a cow if he relied only on beta oxidation of fat, it is possible the liver is pretty good at mobolizing stored energy sources through gluconeogenisis or glycogenolysis of course you would beed a lot of water but those pressure ulcers are fucked

It's true though, in most cases the morbidly obese don't have enough nutrients other than lipids to support themselves.

Not all stored energy is fat the liver also stores glucose as glycogen

He is marked by Nurgle!

Start him on some antibiotics, keep him from eating just provide essential nutrients vitamins minerals and amino acids water, no macro-molecules.

That's a thing that should be very carefully investigated. Sometimes, people have desperate cravings because they're short some vitamin or mineral, and that can be because of a problem with absorption or metabolism. So they get fatter and fatter because they're overeating, but they actually do need much more of something in food than the average person does, and this is the way they get relief from a problem which can kill them if they eat normally.

If that's the case, you have to diagnose and treat that before you try and get them to reduce their food intake.

>I need a lage pizza and a 2 litter diet coke

>optimize his health to be a candidate for gastric bypass
I hope you never become a doctor.

Gastric bypass is an irresponsible and senseless way for doctors to make business for themselves. If he can "optimize his health to be a candidate for gastric bypass" he can lose the weight without that surgery, without its risks and side-effects.

That's not for you to decide, and definitely shouldn't be approached with personal ethical dilemmas

The costs, risks, and potentials are always provided and it's ultimately his choice, if he believes he can make the journey through diet and exercise alone, that's great.

Same logic to ambulatory morbid obese patients whom suffer degenerative effects on their knees, they could lose the weight and reduce subsequent compression and pain substantially by diet and weight loss, or they could elect for knee replacement surgeries and improve their mobility, possibly provide a catalyst to increase exercise

Many obese type 2 diabetics can control their blood glucose levels through diet and exercise to the point of only requiring an oral agent (if anything at all) and wouldn't need potentially dangerous insulin regiments, but some choose not to be compliant with their diet/exercise/DM regiments despite being aware that personal interventions can improve their condition to the point of not requiring to have routine labs and appointments to fuel the business of medicine

Well, then why don't they do that instead of buying him fast food whenever he asks for it?

Honestly they should just give these fatties DNP. Controlled, supervised doses ofc, in addition to a 1000 kcal diet, while they are locked in a prison cell (no pizza deliveries) would work. Shame American laws are so strict. You could make a killing running a fat camp like this in other countries.

That gets used up in about 3 days though if it isn't replenished.

That's why they say to cut carbs for 3 days before taking DNP.

wut is difference hypoxemia and tissue hypoxia senpai

are u retarded? how would it possibly help?

Even a simple gastrectomy would be extremely effective treatment for his condition. Only reason he hasn't undergone surgery yet is due to the high risk of the procedure given how fat he is.

They even pulled the daughter out of school to care for the butterball

It's not like his daughter (and his wife) is a paragon of good lifestyle choices. Let them stay as a family as they slowly kill themselves to death with food.
Shame about the father though, already old and should be retired but he had to refinance his house to pay for their transport and suffered a stroke because of it

Yeah that's basically what I meant. Don't give this guy deep fried fastfood, just give him rice and vegetables or something.

>Daughter
>This guy got laid at least once
>I'm still a virgin

His dick and balls have probably melted by now. Jesus

Would it be possible to literally cut this guy out of his fat? I mean, even if he's just a bunch of organs and what is left of his skeleton in a sealed bag (maybe with most of his arms intact) it has to be better than living like that, right?

At this point it's probably better to encourage him to eat even more. The sooner he dies the better.

Americanism

this is just a test [eqn]k\times\frac{W\times S}{P^{2}}[/eqn]

Fucking this

Don't forget that he cucked someone else as well.

Why even wear clothes at this point

I'm done

>mfw this fatso has a daughter
>mfw he has had sex at some point
>mfw he's even capable of sex
what the fuck

because lean protein and vegetables is like 10 times more expensive than fast food. Not everyone is rich enough to eat perfect food every day.

I can't tell if this is irony or bait.
You might just shop at whole foods though.

>He fell for the healthy food is expensive meme

>>Gastric bypass is an irresponsible and senseless way for doctors to make business for themselves.
>That's not for you to decide, and definitely shouldn't be approached with personal ethical dilemmas
>The costs, risks, and potentials are always provided and it's ultimately his choice
I'm saying it's sold through misrepresentation.

Surgical alterations of the digestive tract for weight loss don't work without patient compliance. Furthermore, doctors typically require the patient to lose large amounts of weight prior to the surgery. You know the real reason they do that? Because it proves the surgery is unnecessary, therefore the desired result is now likely to happen with or without the surgery, so when they go ahead with the surgery, they will be able to claim credit, and further advance the false perception that the surgery is effective.

When they perform the surgery without the patient first losing a large amount of weight, the patient rarely loses weight. Because the surgery isn't the thing that causes the patient to lose weight, his compliance with the diet does. But by performing the surgery, several doctors get paid large amounts of money, and the word gets spread that the surgery causes people to lose weight, so they can get paid large amounts of money again in the future.

Doctors aren't stupid. They know what they're doing. They know it's dishonest and unethical.

There are some procedures that are inherently unethical, because they're ineffective, dangerous, and harmful. This is one of them.

>insulin regiments
>diet/exercise/DM regiments
It's "regimen". A regiment is a military unit.

Actually treating preventable sympoms is different from giving Dumbo a magic feather in the form of risky major surgery with lifelong serious side-effects.

the doctor was so based throughout this episode tbqh phamalam

I was just telling him what fat peoples excuses are

>Honestly they should just give these fatties DNP. Controlled, supervised doses ofc, in addition to a 1000 kcal diet, while they are locked in a prison cell (no pizza deliveries) would work. Shame American laws are so strict.
It's not American laws, it's refusal to treat this sort of thing as a psychiatric disorder involving self-harm.

If they persistently drank too much water to the point of self-harm and danger of death, they'd get locked in a psych ward until they stopped, and then monitored on release and re-admitted if they started the behavior again. It's called psychogenic polydipsia.

Psychiatry is political and acquisitive. There are many fat people. The idea of being imprisoned and prevented from overeating because you're too fat is frightening to them. Therefore, psychiatrists refuse to involuntarily treat even the extreme cases where death is imminent, because it would hurt their public image and reduce their income opportunities. It's better for them to shrug off the responsibility and just sell serious-side-effect-placebo antidepressants to fat people and other vulnerable prey groups.

This is what happens when you hand over an essential societal function to a corrupt group concerned primarily with lining their own pockets.

At least here, in europe, nobody earns a dime doing bariatric surgery.
Patients are explained all the consequences and implications. The thing is that many dont give a shit, they consider surgery itself the goal, like it was some kind of magic pill.

It actually is an useful tool. Its like dog conditioning in a way.
They try to binge, get a really unpleasant response and stop binging. Repeat occasionally untill weight loss or major consequences.
Others learn how to cheat it and binge on honey, for example.

Malabsorbtive procedures do cause direct weight loss too.

I find the wholle thing incredibly disgusting, but eh, im not the one undergoing major surgery, and the state will always find a way to waste my money in useless shit.

As for the ethics of it, they gave ""informed"" consent, the ball is on their roof.
Nobody will really care about someone who doesnt care about himself in the first place.

Now, if actually treating obesity like a psychologic problem werent incredibly offensive, disrespectful and discriminatory towards big boned people, maybe the situation would improve.

/rant

Probably someone too ugly for the typical permavirgin to want to give it up to.

>literally having your intestines rearranged to lose weight
What the fuck man, just eat less.

>At least here, in europe, nobody earns a dime doing bariatric surgery.
Hah! Of course, it's all "free", right? Nobody gets paid? All volunteer part-time doctors who can't quit their day-jobs?

No, even if the state pays for the treatment, the incentives are still there for the people providing it to encourage consumption of more services. If anything, under socialized medicine, the incentives tend to push for less productive activity.

It's like how in the Soviet Union, they controlled the price of bread, so pig farmers bought bread since it was cheaper than pig feed. A bureaucratically-managed economy creates incentives for bizarre behavior.

>No, even if the state pays for the treatment, the incentives are still there for the people providing it to encourage consumption of more services. If anything, under socialized medicine, the incentives tend to push for less productive activity.
Boy you really just fundamentally do not understand how healthcare works outside the US.

Fap! Fap! Fap!

Sure I do. Bureaucrats are in charge of handing out the money. Bureaucrats are never very competent at handling complex issues. Therefore, the way to make money, whether through salary or fee-for-service, is to participate in serious misallocations of resources.

I'm not American, I'm Canadian. We have socialized healthcare, and it's a trainwreck.

American medicine is fucked up in a different way, but it's still generally better than it is in other countries. The excuse propaganda squads for socialized healthcare use for rating other countries as providing better care is that they count American medicine not serving the undeserving generously as a negative. If you have a decent job in America, or had one and retired respectably, you get better healthcare than people at the same income level anywhere else in the world. It's an incentive to be a respectable person. If you have merely respectable income in a socialized healthcare country, you don't get any priority over the trash of your society, who are constantly destroying themselves and therefore consuming a disproportionate amount of the services. As for the rich, they can travel, and they tend to go to the USA for care, which should tell you something.

it would shock the body and he'd die

I meant the doctors have no incentive to push bariatric surgery to ther patients, they do not gain anything but extra work.

In fact they are trying to discourage people from it, thats also a reason patients are forced to lose weight before it. To show them they can do it alone.

My country is broke af and op-theatre time is expensive and surgical deptments generally undermanned, nobody wins.

>they do not gain anything but extra work.
...which they, of course, perform entirely uncompensated.

>My country is broke af and op-theatre time is expensive
How mysterious it is that operating theatre time is expensive, but doctors gain no additional income by performing more operations.

No, but they get paid the same if the operation is bariatric or any other kind. And there is a long ass waiting line for operations so the workload wouldnt change if they were removed.

It is expensive because requieres many highly trained people, high maintenance, a ton of material, drugs and pre and post op hospitalization.
It is not misterious at all.
Its dead fucking simple.

Didnt think that trough, the ones geting px referred from endocrine wards would work less.

But they dont choose the patients so cant push shit.

>this man literally has children
>He has reproduced
>A girl has loved him enough to have intercourse with him
>I am a 6ft guy with a bmi of 21.5
>Kissless virgin
HAS SCIENCE GONE TOO FAR?!!

You are the one falling user

He squats your 1rm for steps

What are you, a fat-shamer?!

>they get paid the same if the operation is bariatric or any other kind. And there is a long ass waiting line for operations
That doesn't mean it would be the same surgeons performing the operations, or the same doctors providing care afterward.

Anyway, keeping the waiting list long is how you stave off cuts and create pressure to increase spending. Waiting lists are inevitable wherever a service is funded by tax money and whoever receives the payments has any possible way to induce consumption.

Look at the next post.
The surgeons do not choose the cases.
They cant go and decide "this fat pos is geting Y-en-roux´d". The patient has to ask for it (many obese people do despite the doctors´ discouragement), or the endocrinologists can suggest it when he deems it adecuate.

Lists are long because the spending is laughable and being repeatedly reduced in
health care.

this has degenerated into shit flinging so dont reply to me or my son ever again

>Lists are long because the spending is laughable
As I've said before, I'm in Canada, and the waiting lists are long here even though the spending is high.

No matter what the budget is, the doctors will find a way to spend it all and say they need much more. "All for the good of the patients," of course.

Fatcuntitis

I have a good solution. These people should smoke crack and be infected with malaria. 100 pounds a week guaranteed.

>your mass correlates with the quality of your food

um

How do people get this fucking huge? How much do they have to eat? Calories in calories out is a meme some people just have a totally shit metabolism.

I'm confused are those callouses on his leg?

In one episode some guy just ate 6-10 large pies and drank 2L every day for every meal.
That's somewhere around 10k cal a day

>Even obese and mentally/physically sick people get laid more than me.
>M-muh survival of the fittest in literal terms.

Time to end it all, boys.

>not looking at the vitals
>no physical examination at all
>ordering crp and esr at the same time when both are signs of inflammation, and both are useless when in such a pro-inflammatory (and procoagulopathic) state
>using vanc instead of benpen on a non-life threatening wound without identifying a resistant organism or trial of less precious abs
>ordering a bnp instead of using the steth to listen for pulmonary oedema
>not considering the diagnosis of thrombophlebitis or deep vein thrombosis given his weight and immobility

C'mon son.

Maybe he wasn't always so fat? Believe me fat people have a really hard time having sex. I tried to fuck a fat woman once and you basically need a meter long dick to even reach her pussy

>it was full of bowel

What
How the fuck is it even possible

I still find it discouraging that a piece of shit like that can get his dick wet at least once and I can't

>treating obesity like a psychologic problem

That's what makes sense to me. I look at it as some kind of addiction.