Tuesday, April 17, 2012

Church booked? Check. Flowers? Check. Feeding Tube? Check?

From the WTF files comes a new trend in wedding preparations - the pre-wedding day feeding tube diet.

For those of you who aren't familiar with naso-gastric (NG) feeding tubes, think a small hose, about the diameter of a healthy earthworm, inserted through your nose and then with the help of you swallowing, passed down into your stomach (and by the way, that photo up above is staged.  Insertion is quite uncomfortable). A balloon on the tip is then inflated so it's less likely to come out and it gets taped to your nose.

There are risks of course (it's an invasive procedure after all). Probably the most common risk is incorrect placement into the airway rather than the esophagus. If unnoticed and someone starts to access the tube for feeding there'll be a very real risk of developing an aspiration pneumonia. More remote risks included a perforated esophagus or a pneumothorax.  There are also very real risks to the very-low-calorie-diets these tubes provide the brides to be in that polyuria (peeing a lot) due to ketosis (the body making its own sugars) can lead to hypokalemia (low potassium) which can lead to cardiac arrhythmias (irregular heart rhythms) and even rarely death (yes, death).

NG tubes are medically indicated to aspirate stomach contents for diagnostic or therapeutic reasons, or to provide a route for feedings or administration of medications when swallowing is compromised (strokes, decreased level of consciousness, etc).

Apparently now they're being used to lose weight before the big day.

Now I'm not going to dwell on the women who've decided the NG tube diet is a good idea. I feel badly for them. Both in terms of the desperation they must feel to go through with it, and for their clearly challenged body images which may well be reflections of weight bias or just our screwed up societal ideals of beauty.

I'd like to focus instead on the physicians who are performing this procedure on women who clearly have no medical indication for an NG tube's insertion. I'd argue the physicians involved are in breach of their Hippocratic oaths, as to put patients at unnecessary risk of infections, perforations, and the cardiac risks inherent to very-low-calorie-diets is contrary to the spirit of "do no harm". Now I realize the Hippocratic oath isn't one that's enforceable (or even one that's taken everywhere), but I'd be shocked if these physicians' respective medical Colleges would approve of this inane treatment, and were someone to lodge a complaint I'd consequently be shocked if the College didn't caution said physician on that practice.  And if their Colleges don't have any concerns, I'd be concerned with their Colleges.

There's no doubt in my mind that eventually, if sufficient numbers of women opted to try the NG tube diet, there'll be a serious medical complication, potentially even a death. I sure wouldn't want to be the physician who inserted the NG tube when that happens as I can't imagine it'll take the prosecutor much time to ascertain that the physician's practice didn't meet the standard of care of medicine.

[Here's a link to the NYT's story on same and photo up above from their as well]