Over 6-8 months, my visits with Antoaneta (every 2 weeks at first, then less often) led to complete relief of her anorexia nervosa. Her weight dipped from 110 lbs (50 kg) at our first encounter to 104 lbs (47 kg) but then began to rise steadily, reaching 121 lbs (55 kg) at our last visit and later achieving a plateau of 140 lbs (64 kg) where she has remained for the last 4-5 years.
Archive for the ‘Stress Relief’ Category
Anorexia Anecdote (5)
Monday, February 15th, 2010Anorexia Anecdote (4)
Friday, February 12th, 2010Antoaneta’s refusal to accept counseling for her anorexia nervosa from anyone but me created the most challenging ethical dilemma I ever faced involving one of my own patients. Fortunately I served for many years as Ethics Director for my hospital and for my medical group and I had learned when faced with two bad options, to try to find a third way.
Anorexia Anecdote (3)
Thursday, February 11th, 2010When Antoaneta insisted she would allow no one but me to counsel her about her anorexia nervosa, my first reaction was that this was analogous to asking a dermatologist to treat your heart attack or a plumber to fix your computer. Even among therapists experienced in treating anorexia, success rates are not ideal. As the NIMH Eating Disorders site puts it, “no specific psychotherapy appears to be consistently effective for treating adults with anorexia.”
Anorexia Anecdote (2)
Wednesday, February 10th, 2010Continuing the story of Antoaneta, I was glad to find that her nutritional status was still within normal values despite her profound weight loss to 110 lb (50 kg) and body mass index of just under 18 (normal 20 – 25). However, a review of her chart revealed steady loss of 7-8 lbs (3.5 kg) every month for over a year and it was clear she would soon be in serious, potentially life-threatening trouble.
Anorexia Anecdote (1)
Sunday, February 7th, 2010Caring for the patient I am about describe was so challenging it could have cost me my job.
Antoaneta was a middle-aged native of an eastern European country who came to the U.S. at age 10. She spoke perfect English with a charming accent and I recalled treating her for irritable bowel syndrome a few years earlier. Now she was referred for a nutritional evaluation. (In addition to my work as a gastroenterologist, I also directed the nutrition support team at the hospital.) The reason for this was that she had steadily lost a total of 113 lbs (51 kg) over the preceding 15 months due to anorexia nervosa. Her primary clinician had already checked for other conditions that might have caused her weight to fall from 223 lbs (101 kg) to 110 lbs (50 kg) on a 5′ 6″ (1.68m) frame but found no other problems.
Empathy and the Mind-Body Problem (6)
Tuesday, January 19th, 2010At a high school track meet some years ago, one of my sons high-jumped over a bar set at 6’10” (2.08m). If I had spent my entire youth with the best high jump coach in the world I could not have come close to that. I remember telling my children that our abilities resemble Manhattan island, with some buildings reaching a great height and others much lower. (My ability in carpentry resembles a hole in the ground in that analogy.)
Empathy and the Mind-Body Problem (5)
Friday, January 15th, 2010Continuing the story of Carla’s uncontrolled vomiting, I had concluded that it was due to her fear of divine retribution for having a child outside of a marriage and then giving the child up for adoption. She feared that God would punish her by causing her unborn second child to be malformed or diseased.
Lecture and Conference
Monday, December 21st, 2009The Stress Check-Up will take a break for the holidays and be back on Monday, January 4. However, I wanted to let my readers know about two opportunities to learn more about stress illness.
The Mayonnaise Jar and the Two Beers
Wednesday, December 9th, 2009When things in your life seem almost too much to handle, when 24 hours in a day are not enough, think about this story that is often quoted on the internet. (If you know the author, please tell everyone by commenting.)
Mental Health Professionals and Physicians (Letter)
Friday, December 4th, 2009Building referral pathways from medical to mental health professionals will be a key part of relieving stress illness. Here is an example of a letter written by a mental health professional to a medical clinician offering ideas that could help. (The references below will be discussed in more detail in a future post.)
