The Day of Endless Injections
Harish Ecna's health check results were shocking.
"It might be better if you see it for yourself. Here."
"Yes, thank you."
I handed him the results translated into this world's language, and the young marquis's face paled instantly. No wonder. Even I was stunned by them.
CRITICAL: Super Morbid Obesity
"The numbers... they're severe."
Having already explained what these figures meant, the young marquis's face was grim. He'd probably gotten a sense of it even before receiving the results. His arm was so thick with fat that measuring blood pressure had been a struggle, and we couldn't even attempt a CT scan. This wasn't just morbid obesity—it was super morbid obesity.
"It's quite serious, but... surprisingly, the other metrics aren't at rock bottom. Liver enzymes are a bit elevated above average, but not badly so. Cholesterol looks fine. Blood sugar is slightly high, but pre-diabetic at worst."
"Then... how should the treatment proceed? Dietary control and exercise together?"
I was struck once again by how quick and sharp the young marquis was. I hadn't even gotten to solutions yet, and he'd already zeroed in on diet and exercise.
"Exactly. For exercise, though, I'd recommend aquatic therapy in the water."
"In the water?"
His question about why water was obvious. My answer was simple.
"Not great news, and I hate to be the bearer, but you're developing degenerative osteoarthritis. Degenerative osteoarthritis is..."
As I explained osteoarthritis, his expression darkened further, and he nodded gravely.
"For the first six months, aim to lose as much weight as possible through exercise. But in your case, surgery will be necessary too."
"Surgery...?"
"Hmm... The most effective option is gastric resection."
"You mean... resecting the stomach inside the abdomen?"
His face filled with horror, so I quickly assured him that general anesthesia meant no pain during the procedure.
"To be precise, it's called bariatric metabolic surgery. Options include sleeve gastrectomy—resecting the stomach lengthwise like a banana to reduce capacity and limit intake; Roux-en-Y gastric bypass—leaving a small pouch near the esophagus, separating the rest of the stomach, and rerouting to the small intestine; or bypass procedures that skip the duodenum, or even further sections of the small intestine."
I skipped gastric banding, which was popular in Korea but fell out of favor worldwide due to complications outweighing benefits.
As I detailed the pros, cons, and side effects of each, his face grew even more troubled.
"Hmm... Is surgery without cutting impossible? I get that it's urgent, but the idea of a knife on my body is... daunting. Plus, I want to lose the weight myself."
Fair enough. Even if his mind accepted the risks, embracing surgery in a world full of amputations wasn't easy.
"I described the most effective methods, but honestly, in your current state, those surgeries are too risky to perform right now."
"W-what? Too risky?"
I nodded firmly at the young marquis, his eyes wide amid the fat.
"For sleeve gastrectomy or gastric bypass, super-morbidly obese patients like you can't go straight in. Remember how I said general anesthesia is required?"
"Yes."
"Anesthetizing you would be tough, and waking up post-op? The fat could block your airway, leading to suffocation. Huge risk."
"G-good lord..."
For super-morbid obesity like his, even anesthesia was a nightmare. We'd struggled just to draw blood earlier.
"That's why I want to start with intragastric balloon therapy. First off, a balloon is—"
"I know what a balloon is. You mean inflating a thin rubber pouch with air?"
West Continent commoners might not even know the word, but a duke's son? Sharp and knowledgeable.
"Right. Intragastric balloon means inserting a long tube with a special balloon attached through the mouth into the stomach and inflating it there. It fills space, making you feel full so you eat less."
"Fascinating... no appetite at all..."
I shook my head at his musing.
"It creates satiety like a full stomach, so you might think you can eat less. But if you've always enjoyed food like you have, suppressing actual hunger is hard. Your mouth craves it, but your stomach feels stuffed—could be worse."
"Then... that's for me to overcome."
No whining or 'how do I endure?'—just resolve. Impressive.
"Many patients do see appetite suppression, so don't worry too much. Safer than other surgeries, a bit uncomfortable, but if you can tough it out, it's simple—no anesthesia needed."
"Makes sense. Just shove a long tube down the throat."
Studies show non-surgical treatments like meds average 6-8% total weight loss; balloons hit 16-18%.
Even if he goes nuts with diet and exercise for 20% loss, that's still 260.8 kg. Blood pressure's high, and his joints won't survive.
His face brightened as I explained the balloon, but I remained uneasy. He wanted non-surgical, but he needed sleeve or bypass.
Can't force surgery on a reluctant patient... Wait, his jaw?
His original reason for visiting popped into mind: jaw fat removal.
"Looking at you now, there's another option. Pair it with the balloon to melt fat directly."
"R-really?"
"Yes, but it means injections all over your body. Painful. And the cost..."
"Don't worry about cost."
Music to my ears. I wasn't really worried anyway—just protocol.
"It's deoxycholic acid injections. Called Violet shots."
"Violet?"
The same double-chin treatment Baron Radius—Gregory Balio's cousin—got. Not yet approved for other areas by this world's FDA equivalent.
But it'll work elsewhere too. It did on Belkyra cases.
I explained efficacy, side effects, and precautions just like with the baron. I thought of Violet over lipo because it's a knockoff/improvement of Belkyra (Korea) / Kybella (US/global).
Violet's a quarter the price, double concentration. Same deoxycholic acid anyway.
Overseas, Belkyra/Kybella is used on arms, thighs, knees, back, waist, glutes—not just chin in Korea. Violet's pending approval there for deep cheeks and arms.
Great if I wait, but no FDA here. Save the patient first.
I swear I heard the FDA chief smiling approval.
—Never approved it, you quack!
Shook off the weird thought. Patient waiting.
"Please wait here a moment, Young Marquis. We'll start with Violet. Before the procedure room, we'll move you to the treatment bed."
"Kyuuu—"
"Kyuuuuw—"
"Pardon?"
Instead of a reply, weird sighs. Looking at him, he chuckled.
"Haha, not me—the pangolins. They make that sound when bored."
"Ah, got it. I'll have staff bring the bed..."
"Kyuuuuw—"
"Kyu—"
"Kyuuu—"
"..."
His pangolins understood speech. Those deep sighs? Pleas to move him to the bed ASAP.
"See you shortly."
"Yes, I'll prepare myself."
Even as I left the inpatient room, the pangolins kept sighing deeply.
This bariatric treatment wasn't just for him.
Pangolins... hold on. I'll save you.
Tick—
Tick-tick—
Tick—
Out in the hall, I sent a group message via the crystal orb to the witches, Jo family, and even Res.
This would be the day I'd given the most injections in my life. Probably ever.