"Every hospital has had cases of seriously obese patients who challenge the ingenuity and patience of caregivers, but no one talks about them," said Michael Dionne, PT, owner of Choice Physical Therapy Inc. in Gainesville.
Dionne specializes in providing care, rehabilitation and encouragement to patients whom he calls "people of size" (up to 500 pounds) and "people of immense size" (500 to 1,000 or more pounds).
 Photos by BARRY WILLIAMS/Special |
| Michael Dionne (left) works with Richard Turk in a therapy pool at Northeast Georgia Medical Center's outpatient facility in Gainesville. In the pool, bariatric patients are able to exercise in a low-impact environment. |
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| Michael Dionne (left) leads Timothy Jackson through an arm-cycling workout. |
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| Michael Dionne puts Richard Turk through a workout on a stationary bike. The seat has been removed so that Turk can sit on another chair that supports him. |
Obesity is growing by epidemic proportions in this country, Dionne said.
"We're seeing more patients of size, and we're seeing them more often, because they are living longer," he said. "In the 1980s, if a person of size spent four to six weeks on a ventilator for assisted breathing and acute management for heart failure, his life expectancy was five years. Modern medicine has changed that."
Dionne offers continuing education courses, seminars for health care professionals and charity consultation visits with patients and at hospitals. Through these educational efforts, he talks about the need for sensitivity and safety training when dealing with morbidly obese patients. He also teaches techniques for providing rehab therapy for obese patients.
Dionne's work with heavy patients has helped him to see beyond the stereotypes about obesity.
"It's not just a behavioral problem. There are many causes, and the patients are individual, often courageous, and deserve respect," he said.
Medical professionals have identified two body types in the obese population: apple and pear shapes. Through his practice, Dionne recognized that there was a greater diversity in weight distribution among obese patients. He discusses that diversity with health care professionals and in his book "Among Giants: Courageous Stories of Those Who Are Obese and Those Who Care for Them" (Lulu Press Inc., 2006).
Understanding these differences can help doctors, nurses and therapists better care for their obese patients.
Using a bariatric triad — an appropriately weight-rated bed, a portable lift and an oversized wheelchair — health care providers can improve the care of obese patients.
"The answers are there, and, with them, we could revolutionize the care for this patient population," Dionne said.
Dionne has seen miracles happen, when the creativity and determination of therapists and nurses meet the indomitable spirit of a patient who wants to survive.
Such was the case in Dionne's work with "Jake", a 1,000-pound patient with the mental capacity of a 4-year-old, who was admitted to a hospital with severe respiratory and heart problems. It took two crews of firefighters to transport him to the hospital.
A life-saving operation left Jake in a weakened condition and with a 40-inch surgical incision that required whirlpool wound-care treatment. But Jake was willing to work hard to get better.
And Dionne was determined to make sure that his patient showed enough progress to keep his health insurance. Many bariatric patients are left without health insurance, because they often can't meet progress goals as quickly as normal-sized patients.
Using a bolted hospital bed, a freight cart and a specially designed bench, Dionne was able to push Jake into a standing position. By the time he was discharged from the hospital, Jake could walk 75 feet at a stretch.
With the help of gastric bypass surgery, the surgical removal of extra skin, a portable oxygen tank and an empowered spirit, Jake lost more than 500 pounds. He was able to walk a mile every day and greet friends in his neighborhood.
Unfortunately, Jake died five years after his initial hospital stay.
In his book, Dionne wrote that "Jake would not have had those five years without the remarkable efforts and life-saving decisions made by his medical friends in the ER and ICU upon his admission. . . Jake was a unique individual with an expressive and creative spirit, always wishing to be a positive participant in the world."
Many hospitals are making strides in caring for heavy patients by creating no-lift environments and purchasing specialized equipment. Some hospitals have put in bariatric suites with double-door entries, weight-rated beds and ceiling-mounted lifts.
Sensitivity training for hospital staff also helps create better patient outcomes.
"When a frustrated staff member vents to others about a patient of size, the negativity grows," Dionne said. "It's hard for [a nurse] to walk back in the patient's room and care for him sincerely, and the patient knows when someone isn't sincere.
"We need to turn the tables on the stereotypes, quit being judge and jury, and help the person get to the next level of wellness."
Dionne hopes to create the first long-term, bariatric rehabilitation center in the South.
"Pool therapy is the best therapy, but [it's] costly," he said. "It's my dream to prove that rehabilitation can become cost-effective for this patient population."