# Underdosing Plus-Size Female Chemo Patients



## Ned Sonntag (Jan 5, 2009)

Chemo's been given based on 'ideal weight' vs actual weight. Results not good.
http://www.al.com/health-fitness/birminghamnews/index.ssf?/base/living/1231146940193130.xml&coll=2


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## Indy (Jan 5, 2009)

Interesting article, I'm a 5 year survivor of a different type of female cancer who had chemo and radiation at the same time. My docs seemed to think my size helped prevent some of the debilitating side effects. I think it is important to go to a major medical/research center if possible to get the latest protocols available


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## Webmaster (Jan 5, 2009)

I think that's a very important issue whose implications go well beyond chemo therapy. In my experience, fat people often do not receive proper dosage because doctors don't want to put themselves at risk for a law suit by prescribing anything but standard dosages. I've seen infections get out of hand because of underdosage in fat patients and many other examples where drugs failed to work due to improper dosage in very fat patients. This is a very real issue that should be put on the table. 



Ned Sonntag said:


> Chemo's been given based on 'ideal weight' vs actual weight. Results not good.
> http://www.al.com/health-fitness/birminghamnews/index.ssf?/base/living/1231146940193130.xml&coll=2


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## Ned Sonntag (Jan 5, 2009)

The Animal Clinic will not clean my 28lb cat's teeth because they don't know how much dope to give him. It never ends.


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## No-No-Badkitty (Jan 5, 2009)

Ned Sonntag said:


> The Animal Clinic will not clean my 28lb cat's teeth because they don't know how much dope to give him. It never ends.



If they seriously don't know how to sedate your cat get a new vet. It would be unlikely they would be competent enough to clean the teeth. Iso is very safe, it's hard to OD a cat (or any animal) when it comes to that particular anesthetic.


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## Ned Sonntag (Jan 6, 2009)

No-No-Badkitty said:


> If they seriously don't know how to sedate your cat get a new vet. It would be unlikely they would be competent enough to clean the teeth. Iso is very safe, it's hard to OD a cat (or any animal) when it comes to that particular anesthetic.


 Hadn't thought of that. I'll make inquiries. This is the vet clinic I've used for 20 years. I think they want me to put Fred on a diet. Might as well go straight for the WLS... wait they'd have to dope him for that too.:doh:


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## indy500tchr (Jan 6, 2009)

Ned Sonntag said:


> The Animal Clinic will not clean my 28lb cat's teeth because they don't know how much dope to give him. It never ends.



Well how do they sedate 28lb. dogs to clean their teeth?


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## Melian (Jan 6, 2009)

missaf said:


> I'm still trying to understand this. Medications are given based upon the dosage to be therapeutic and the weight of the patient by default. So if I need 100mg/kg to be cure of something in so many doses, what's the issue of doing so for a cat? Why would you switch to ideal weight instead of actual? That's lame.
> 
> Duh.



This is exactly what I was thinking! I'm a bit biased (PhD vs MD....), but far too many doctors have no idea of what they're doing. They can recite their standard doses, but are completely ignorant to the basic pharmacology behind the drugs they prescribe. 

I'm not going to launch into a receptor kinetics rant (because it would be boring and no one would read it ) - just wanted to express some general disgust at the medical system.


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## bigsexy920 (Jan 6, 2009)

I have Leukemia and thankfully I never had to have chemo but I am on Gleevec for - well ever - and the normal dose is 400mg but my Dr due to my size gives me 800mg. I have to say I have a great Dr. and has always been wonderful to me and he has always taken my size in his decissions with my medication. 

In fact when the hospital would not do my bone marrow sample. I went to him crying very upset. He and another Dr. did it right in his office. I felt no pain and he got a great sample. I love him for all he has done for me.


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## SocialbFly (Jan 11, 2009)

Webmaster said:


> I think that's a very important issue whose implications go well beyond chemo therapy. In my experience, fat people often do not receive proper dosage because doctors don't want to put themselves at risk for a law suit by prescribing anything but standard dosages. I've seen infections get out of hand because of underdosage in fat patients and many other examples where drugs failed to work due to improper dosage in very fat patients. This is a very real issue that should be put on the table.



the problem lies in the fact that fat is not well perfused and if you dose based on weight you will overdose the patient, for example most of the time an average adult dose of a drug might be 2grams, based on patient weight you might want to double that, but unfortunately, God (or whatever you believe) didnt give us plus sized kidneys or livers, they still have to filter based on size, so, that is a dilemma. Chemo is even worse as some of it attacks the heart too, which we already stress with our big bodies.
When i was saying about fat not being well perfused too, it means it takes longer to cure an infection there, due to less blood flow, now the side effect as well to anesthesia etc is that it likes to sit in fat cells only to be absorbed later at a different rate, due to the lack of perfusion (or blood flow) to the area...i have seen docs go to the highest doses advisable in the dosage range for larger patients, but since most drug testing is done on average sized males, who knows.

we BBWs and SSBBWs (or i should have said BBPeople eh?) are hard to dose for that reason, i am not sure what the answer would be, higher doses might be called for, but the cure shouldnt kill, and that is what i wonder if it wouldnt be the issue.


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## Miss Vickie (Jan 11, 2009)

What Di says is true. Plus, not all medications -- and in fact most medications -- aren't based on dose per kilo. I give a lot of medications at work -- everything from tocolytics to painkillers to antibiotics -- and rarely does a patient's weight play a part in adults. (In kids it's another story altogether). We all get the same Percocet, the same Zofran, the same Toradol. And I've had 300 pound girls have profound effects from the same dose of an IV med that I give a 100 pound girl with minimal effect. So clearly there's more to it than weight particularly as Di says, since fat is not well perfused.

It would be ideal if we could tailor doses (and medications) to patients more specifically, but the data just isn't there, yet. In the meantime we work with what we've got while supporting more research. But I'd be afraid to give a 300 pound woman twice the dose of a 150 pound woman. Just because we're bigger doesn't mean we need higher doses.


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## Green Eyed Fairy (Jan 11, 2009)

Thank you Di and Miss Vickie for your valuable input into this......it really does help reading the medical knowledge of two other BBWs regarding this issue.


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## SocialbFly (Jan 11, 2009)

Miss Vickie said:


> What Di says is true. Plus, not all medications -- and in fact most medications -- aren't based on dose per kilo. I give a lot of medications at work -- everything from tocolytics to painkillers to antibiotics -- and rarely does a patient's weight play a part in adults. (In kids it's another story altogether). We all get the same Percocet, the same Zofran, the same Toradol. And I've had 300 pound girls have profound effects from the same dose of an IV med that I give a 100 pound girl with minimal effect. So clearly there's more to it than weight particularly as Di says, since fat is not well perfused.
> 
> It would be ideal if we could tailor doses (and medications) to patients more specifically, but the data just isn't there, yet. In the meantime we work with what we've got while supporting more research. But I'd be afraid to give a 300 pound woman twice the dose of a 150 pound woman. Just because we're bigger doesn't mean we need higher doses.



I agree....


I would rep you, but alas the rep Gods are against me, i owe you, and thank you.


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## Webmaster (Jan 11, 2009)

I am sure you're right. I am not an MD and base my concern on what I have witnessed and what seems to make logic sense. Maybe the biggest problem is that fat patients are often a challenge for physicians and healthcare staff as they just don't quite know how to deal with them. I've seen everything from total enlightenment and genuine concern all the way to hostile attitudes and open contempt.



SocialbFly said:


> the problem lies in the fact that fat is not well perfused and if you dose based on weight you will overdose the patient, for example most of the time an average adult dose of a drug might be 2grams, based on patient weight you might want to double that, but unfortunately, God (or whatever you believe) didnt give us plus sized kidneys or livers, they still have to filter based on size, so, that is a dilemma. Chemo is even worse as some of it attacks the heart too, which we already stress with our big bodies.
> When i was saying about fat not being well perfused too, it means it takes longer to cure an infection there, due to less blood flow, now the side effect as well to anesthesia etc is that it likes to sit in fat cells only to be absorbed later at a different rate, due to the lack of perfusion (or blood flow) to the area...i have seen docs go to the highest doses advisable in the dosage range for larger patients, but since most drug testing is done on average sized males, who knows.
> 
> we BBWs and SSBBWs (or i should have said BBPeople eh?) are hard to dose for that reason, i am not sure what the answer would be, higher doses might be called for, but the cure shouldnt kill, and that is what i wonder if it wouldnt be the issue.


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## SocialbFly (Jan 11, 2009)

Webmaster said:


> I am sure you're right. I am not an MD and base my concern on what I have witnessed and what seems to make logic sense. Maybe the biggest problem is that fat patients are often a challenge for physicians and healthcare staff as they just don't quite know how to deal with them. I've seen everything from total enlightenment and genuine concern all the way to hostile attitudes and open contempt.



and even as a healthcare provider, i have to agree with your comment, but as a fat nurse, with 29 years of experience, it is MY job (and indeed all of ours) to educate them with confidence and compassion, even if we dont get it from them, stupid people cant help but be stupid and having someone who has some knowledge in your corner is never a bad thing...but i have to agree with your statement as a whole...medicince needs to get over itself and deal with the majority of what the population is, that they have no idea about or unfortunately, how to treat adequately.


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## Risible (Feb 5, 2009)

This info deserves a second look - thread bumped.


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