It was a complicated case involving multiple diagnoses, pre-existing conditions and complications. The bariatric patient needed ventilator weaning and physical therapy - a more extended, specialized hospital experience.

Fortunately for Philip Braxton, there was Select Specialty Hospital in Memphis. Braxton, 30, from Isola, Miss., had been transferred from Baptist Memorial Hospital DeSoto where he had been treated for cellulitis and stabilized after going into cardiac arrest. He had an NG feeding tube, a ventilator with a tracheostomy and was also under treatment for anxiety and agitation. He was suffering from congestive heart failure, high blood pressure and diabetes—a triple threat for patients like Braxton, who weighed over 400 pounds.

“Everyone that size has some degree of congestive heart failure and high blood pressure, and a lot of them are diabetic. All of this goes together. When you have heart failure, you retain fluid, so it causes the high blood pressure and that also causes kidney problems,” said Lorie Dennis, R.R.T., Pulmonary Program Manager and 11-year Select Specialty veteran.

Select Specialty Hospital, a smaller, 38-bed hospital, has complete services for bariatric patients. A multidisciplinary team works in tandem with customized equipment and therapies to improve the medical condition of the morbidly obese patient while meeting nutritional, respiratory, pharmacological and other needs.

“There is a weekly team meeting on every patient that includes respiratory therapy, the dietitian, wound care, nursing, case management, pharmacy, rehab and the medical director. There is an education component also available for family and caregivers. We have a comprehensive approach,” said Dennis.

All patients receive a multidisciplinary consult upon admission, with respiratory, occupational, physical and speech therapies represented as well as pharmacy, dietary and wound care, if needed. Caring for bariatric patients can be a delicate balance.

“If the patient isn’t getting the right nutrients, he can’t work out to increase strength. From a renal standpoint, if there is too much fluid, it backs up and affects his vent weaning,” Dennis said. “Where do you start? You start with all of it.”

Braxton did have kidney insufficiency on top of the diabetes, high blood pressure and congestive heart failure. He was also septic, with a combination of pneumonia, a urinary tract infection and a blood infection. His history included an underactive thyroid gland and pituitary problems necessitating a childhood surgery, on top of a seizure disorder. He was unable to complete tasks for daily living, such as dressing, bathing and even eating.

“He came in on an NG tube and ventilator, so we did a bedside swallow assessment to see if his swallowing was safe. Then we went on to modified barium swallow tests to be assured he was swallowing properly. Aspiration (food entering the lungs) would have just complicated things and kept him on the ventilator longer,” said Beverly Hayes, S.T.

While the main goals were to get Braxton breathing on his own again and consuming regular foods, there were also mobility and functional issues. To address mobility while patients are recuperating, Select has customized beds designed to hold patients up to 800 pounds, bariatric wheelchairs, special lifts, sliding boards for transfers, inflatable air mattresses that “float” to help move patients and modified beds transforming into chairs to help patients stand. Then there is physical and occupational therapy to help patients like Braxton attain a higher level of functioning.

“We try to get them out of bed and moving at least twice a day,” said Nancy Fulfer, P.T., Lead Physical Therapist. “All of our staff are required to take bariatric training as part of their initial employment training. It’s not just the PTs that do it.”

In Braxton’s case, after four weeks of intense physical therapy for mobility and speech therapy to work on swallowing, he was able to walk with a walker and consume a regular diabetic diet. He left Select weaned from the ventilator, stabilized and infection-free to complete more physical rehabilitation at another facility to optimize his functioning.

In the event a bariatric patient needs dialysis, total parenteral nutrition or prolonged antibiotic therapy, Select is prepared. There is a 24-hour on-site pharmacy, a clinical dietitian and nutritional counseling. Select also sees obese patients for post-operative care, including post-gastric bypass surgery, post gastric banding surgery or in the event of any post-operative complications.

“Sometimes they have surgeries that are routine for others, but because of the obesity they don’t heal,” said Fulfer. “It can be a diabetic issue or just because the integrity of the bariatric patient’s skin is different.”

Select’s small setting assists them in providing focused, personalized care. Select Specialty Hospital-Memphis is well recognized among other Select Medical Corporation hospitals around the country, winning three awards for excellent achievement. High patient satisfaction scores testify to the success of their approach.

“A long-term hospitalization means a real loss of control for the patient. They have to rely on everybody,” said Dennis. “We have to earn their trust.”

Select Specialty Hospitals are part of a national network of specialized acute care hospitals within Select Medical Corporation.  All Select Specialty Hospitals are JCAHO accredited, Medicare certified and licensed by the state in which they are located.  They are also participating providers with a wide variety of HMOs, PPOs and Managed Care plans.