They may not admit it, but some physicians around the country are asking veterinary facilities to image their morbidly obese patients. They are inquiring about airlifting out-of-state patients and even transferring them directly to animal hospitals with emergency personnel.

Some hotly dismiss such scenarios as myths, but William Blevins, DVM, MS, knows otherwise. The professor of diagnostic imaging at Purdue University's Veterinary Teaching Hospital in West Lafayette, Ind., received a call a few years ago from a local hospital alerting him that a patient was on the way for imaging.

"Yes, already in the ambulance and on the way," says Dr. Blevins, who promptly sent the patient back. He says the legal ramifications of imaging people at vet centers "are so complicated that we simply cannot become involved."

Desperately seeking imaging

Dr. Blevins isn't alone. ADVANCE found 15 veterinary doctors around the country who get between a few calls a year to three a month to image morbidly obese people. (Sixty-six percent of adults are overweight or obese, and 6 million adults are morbidly obese-100 pounds overweight, according to the 2003 National Health and Nutrition Examination Survey and American Society for Bariatric Surgery.)

"They are wanting to do the very best for their patients and are desperate to image these large patients," says John Hathcock, DVM, MS, DACVR, radiology section head of Auburn University's College of Veterinary Medicine in Auburn, Ala.

However, although some veterinary facilities have imaging tables that support 2,500-pound animals, their gantry bores may not exceed 70 cm-similar in size to those in hospitals. And unlike imaging equipment for people, veterinary imaging devices do not require U.S. Food and Drug Administration approval.

Alexia McKnight, DVM, DACVR, and veterinary radiologist at University of Pennsylvania's New Bolton Center for large animals in Kennett Square, Pa., hears growing frustration and even anger in the medical community as it struggles to provide imaging services for a physically larger patient population.

"I remember specifically this one ornery physician was insisting that we've [imaged patients] in the past and that we need to do this for his patient," she says.

While Dr. McKnight's requests are generally from regional clinicians, Mauricio Solano, MV, DACVR, assistant professor of radiology at Tufts University's Cummings School of Veterinary Medicine in North Grafton, Mass., has received inquiries from hospital physicians in Maryland and Ohio asking to airlift their patients to his New England veterinary school.

It's uncertain who these referring doctors are. Those making the calls are not revealing much about themselves, and the rest of the medical community seems out of the loop or understandably skeptical. Indeed, 10 physicians and health care professionals on ADVANCE's editorial board had never heard of patients being referred to veterinary facilities. Several suspected the notion was urban legend, while one health care administrator called the question "weird."

Recently, the media has grabbed onto the story. In a January article on the growing need for specialized care for obese patients, The Washington Post mentioned a family practitioner in Northern Virginia who called veterinary schools earlier in his career to help an obese man.¹ And an infamous New York Post story in May 2005 tells of a woman who claims a Brooklyn hospital physician referred her to a local zoo for an MRI.² Even primetime television is in on the action. The NBC comedy Scrubs aired an episode in April in which physicians referred Herbie, a morbidly obese patient, to the zoo for imaging because he didn't fit in the hospital's MRI machine.

Imaging examples

Though most animal facilities will not image people because of liability, some have done so. At Auburn University's College of Veterinary Medicine, Dr. Hathcock recalls three patients who were imaged on the school's MR and computed tomography (CT) machines: a 320-pound football player with a bad back, a 500-pound patient experiencing pelvic pain, and a geriatric power-lifter with back pain.

The patient with pelvic problems was referred by an emergency room physician on Christmas day. Dr. Hathcock suspects radiologic technologists at the hospital where he was imaged were not well-trained or lacked experience with large patients.

"Our techs are accustomed to big body parts-and were able to get some images," says Dr. Hathcock. "I do not know if they were good enough for him, as [the physician] never called back one way or another. So much for a Merry Christmas."

Years ago, Oklahoma State University's Center for Veterinary Health Sciences in Stillwater imaged a patient suffering from chronic biliary obstruction on a now-defunct piece of equipment. "I thought the image looked awful, but the MD said he was satisfied with the results, thanked us and left," says Robert Bahr, DVM, DACVR, associate professor of veterinary radiology at the center.

The Virginia-Maryland Regional College of Veterinary Medicine in Blacksburg, Va., has imaged human cadavers for researchers. Ohio State University's animal hospital director in Columbus is open to human imaging if liability waivers are signed and a medical team performs the procedure. Colorado State University's College of Veterinary Medicine in Fort Collins, Colo., is seeking approval for human MRIs for research, although administrators are proceeding cautiously, says Susan Kraft, DVM, PhD, DACVR, associate professor of radiology at the college.

Withstanding legal ramifications, some veterinary doctors are philosophically opposed to using their equipment for people. "I think it is degrading to ask a human to lie on a horse table, not to mention any liability issues," says Sue Newell, DVM, MS, DACVR, veterinary radiologist at Ocean State Veterinary Specialists in East Greenwich, R.I.

One patient's experience

Lynn McAfee, director of the Council on Size and Weight Discrimination advocacy group in Mt. Marion, N.Y., dropped from 520 pounds to under 400 over the last several years. The Stowe, Pa., resident, who sees a doctor monthly for everything from pulmonary hypertension to sleep apnea to arthritis and a tumor in her heart, says she now fits into one local CT machine. But that wasn't always the case.

In the late 1990s, she was referred to a local veterinary hospital for imaging because she could not fit into the equipment at nearby hospitals. Though the animal facility would not image her, she says a surgeon at a hospital agreed to operate on her "blind" because physicians had diagnosed her abdominal problem as cellulites, a life-threatening bacterial infection. It turns out McAfee only had a hernia and was left with massive scarring and Grade 3 lymphedema, a deforming skin condition known as elephantiasis, she says.

Now she advocates for obese people's medical rights and offers tips to improve their clinical experiences. For instance, McAfee suggests they schedule separate appointments to see if they fit into imaging equipment, and encourages them to call imaging manufacturers to verify actual weight limits, since some vendors post lower limits for warranty reasons.

"We are people who have different needs," McAfee says. "Many times, people are let go because there's nothing that can be doneI think doctors who grasp at this vet thing just want to tell people something [can be done to help them]."

References

1. Levine, S. (2006, Jan. 3). Obese patients increase need for specialized medical care. The Washington Post. p. A01.

2. Montero, D. (2005, May 23). Docs told me to try hippo MRI. New York Post. p. 17.

Jill Hoffman is an associate editor of ADVANCE.