Extreme weight loss

[Teresa__0__0]

  Hello,
  My mother has experienced severe weight loss since February
  of this year, dropping from 170 pounds to 125 pounds. She is
  about 5`7. She has undergone several tests--ultrasounds (upper
  lower), gastroscopy, barium enema, lower GI, and xrays. Her
  doctor did find evidence of h.pylori, and she was treated for
  this problem. Her weight loss, however, continued. She does not
  feel pain, but explains that the food that she eats causes her
  discomfort, that it just sits at the bottom of her stomach. She
  does not complain of heartburn, she does not feel nausea or want
  vomit. Her bowel movements are normal. She has cut back her food
  intake dramatically in these months, and now eats very little. She
  is afraid to eat food that is not mashed, as she thinks that it
  will be more easily digested. She has been drinking Ensure.
  She is being treated for depression with serzone. She has been
  on serzone for about 6 weeks (now at 400mg/day), and before that,
  she was taking sinequan, but at a very low dosage (20mg/day). She
  also takes small doses of predinisone (5mg every 3 days) for
  polymyalgia, estrogen, and ativan (for anxiety). She was diagnosed
  with another depression 28 years ago, and at that time, she lost
  the same amout of weight. She notes that 28 years ago, however,
  she had no apetite, while she feels that she CANNOT eat now (even
  if she had an appetite). She also complains of pain in her lower right-
  hand quadrant, and feels a lump (the size of a kidney) there. A
  radiologist told her that it was likely her kidney that she feels
  as she is very thin. Do you think that the weight loss, and her
  difficulties in eating are connected to her depression? Could
  there be a physical reason that the doctors have missed? Her
  gastro-intestinal specialist asked her to do a CAT-scan, but she
  is afraid that she is allergic to the dye? Is this a useful test?
  What happens if patients are allergic to the dye? We want to help
  stop the weight loss and help her feel better, but we are not
  sure what to do, other than encourage her to eat and help her
  through the depression. We are afraid that her weight is getting
  dangerously low--what IS a dangerous weight for a woman her
  height? Please help.
_____________
Dear Teresa:
Causes of weight loss are too numerous to list.  With the brief medical history provided in your email, it is very possible that your mother’s weight loss may be due her severe depression, especially since she had weight loss and depression when she was younger.  However, it is necessary to exclude other treatable causes of her weight loss before attributing her weight loss solely to her depression.  First of all, malabsorption (the small intestines not absorbing the nutrients due to various conditions) should be considered. Upper endoscopy with small bowel biopsy will determine if this is apossible explanation.
A second possible cause is occult malignancy such as pancreatic cancer, ovarian cancer and lymphoma, to name a few.  A CT scan of the abdomen is necessary to exclude these possibilities.  In patients who have allergic reactions to the contrast dye, corticosteroids and anti-histamines administered before the dye can prevent problems.  Other possible explanations for the weight loss include gastroparesis and mesenteric ischemia ( a condition in which the intestine has an inadequate blood supply when it is working during digestion.  Patients have severe pain with eating and subconsciously restrict food intake in order to prevent the pain.  After a while they forget about the pain and the only symptom is weight loss.

Your mother is now underweight.  I suggest that you discuss with your physician nutritional supplements.
This information is presented for educational purposes only.  Always ask specific medical questions to your personal physician.
We would be happy to see your mother at Henry Ford Health System, Division of Gastroenterology.  Call pour Physician Referral Line at [phone] and request an appointment with Dr, Muszkat, one of our experts in nutritional disorders.
HFHSM.D.-rf
*keywords: weight loss,
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