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Geriatric Medicine/unexplained unexpected weight loss

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QUESTION: Hi Gayle!

I am an 80+ year-old white male in good health except for
atrial fib.

My concern is weight loss...
In Summer of '13, my weight was 176 lbs.
In Summer of '15, my weight was 165 lbs.
In Summer of '16, my weight is  160 lbs.

I eat well, I sleep well, I get little exercise.

Should I be concerned? does the weight loss imply a serious condition/illness?

I look forward to your reply.

Chris

ANSWER: Dear Chris,

Based upon the limited information provided my gut instinct would be to say no because it appears to be a gradual weight loss over time and sometimes when individuals get older, their appetite is not as good as during their younger years. This may be due to many things such as: going out to eat less, no longer being in the work force, decrease in the functioning of taste buds, not feeling like cooking,... or any number of things.

With that said, you must be concerned about it or you would not have written to me.

Probably the single greatest missing piece of information in putting the whole picture together for/with you would be to know how tall you are. Knowing your height would allow me to determine your body mass index or BMI, which essentially is a number computed after height and weight are entered into a particular equation.  Knowing what your BMI is would allow me to be able to tell you if you are a)obese - this would be a BMI of >30; b) underweight or anorexic - a BMI which is under 20.

Without knowing your height I am very limited in my advice to you except to say that if you feel well, sleep well, can perform your normal activities of daily living, and you are not depressed, then most likely nothing serious is going on. If you feel high levels of energy then you might ask your medical provider to order a thyroid panel of lab work. If your thyroid is working too hard, it could cause you to lose weight.

It would also be helpful to know the following:

1. What other medical problems due you have? i.e. diabetes, high blood pressure, high cholesterol, arthritis, asthma or COPD...

2. Do you smoke? Do you consume more than one alcoholic drink daily?

3. Do you get out of the house regularly or do you feel isolated? Is it possible that you could be experiencing a mild case of depression? Have you recently experienced any loss of family members or close friends?

4. What medications do you take? Some medications may cause a loss of appetite?

5. Have your medical care providers, friends or family brought this weight loss to your attention?

6. Do you feel weak or unable to do things due to the weight loss? Do you catch colds or other respiratory infections more easily because your immune system may be lower than it has been?


It would be very important for me to at least know your height, medications you are taking, any other medical conditions that you have or have been treated for in the past, and any symptoms you may be experiencing as a result of the weight loss, i.e. weak, fatigued, dizzy, you tire easily... in order for me to provide you with a more comprehensive educated guess as to possible reasons for your weight loss and whether or not to be concerned about it.  Certainly if this has been causing you a great deal of anxiety, you should make an appointment with your primary care provider to have a complete physical exam.

I would be happy to re-evaluate your current situation after you provide the additional information.

Best Wishes,

Gayle

---------- FOLLOW-UP ----------

QUESTION: Your reply, Gayle, says lots about you. It says that you are a caring person, whether the other guy/gal is sitting in front of you or is 1000 miles away.
They don't make them like that anymore!

To answer your questions...
My height is 6'1".
I keep my cholesterol and blood pressure in the normal range by medication.
I have atrial fibrillation.
I don't smoke. I drink hardly any alcohol.
I spend most of my time at home, but I don't feel isolated.
I am happily married. I see friends from time to time.

I will be seeing my PCP in less than a week.

I thank you again for your thoughtful,caring reply.

Chris

Answer
Hi Chris,

Thank you for your kind words.

With the new information I did some research to find a website that would compute your body mass index (BMI). In checking different sites I found that some of the online systems which calculate BMI will also figure in age, gender, and the country where you live (I'm assuming it's the U.S. because generally if I get a question from another country the person will state that fact; most often the other country is India.)

Your BMI is NORMAL at 21.1% and it places you at the 12th percentile for your age. I believe the percentile figure is the same one used for pediatrics, adjusted accordingly. So while you are in the normal range still, a LOT of people your age and height will weigh more than you. I believe I incorrectly stated that <20 was considered underweight. The most current literature is now using <18.5% when intending to use a diagnosis of underweight. Just for ha-ha's I tried to see what would happen if you lost more weight or grew taller (the system wouldn't let me change your age or gender).

Here's what I found:

If your weight dropped to 140 lbs then your BMI would drop to 18.5%.

If you grew 5 inches taller but maintained your current weight then your BMI would also drop to 18.5%.


Summary

Looking into my crystal ball I would say that you inherited good genes, you take good care of yourself, take your medications as directed, and by keeping active you keep those brain cells functioning at their greatest level. If you wanted to change anything you could implement a daily or 3x weekly exercise program alternating walking for the aerobic benefit and light weight training - nothing you need to go to a gym to do. In place of weights you could substitute cans of soup or vegetables, because it's not so much the amount of weight you're using but more importantly that you are using different muscle groups and keeping them toned which will help with balance and reflexes. If you decide to implement any type of exercise program of course you would mention it to your PCP and you should also increase the amount of protein in your diet to aid in building muscle and preventing muscle breakdown if your body tends to go into a fat-burning mode easily.

Keep doing what you're doing, you're a great example for those around you that are your age and for those who are aspiring to reach your age. I didn't ask this, but I'd bet that longevity runs in your family as well. It sounds to me like your insurance company should put you on a t.v. commercial!

Take Care,

Gayle

Geriatric Medicine

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Gayle Gwozdz

Expertise

My name is Gayle and I am an adult nurse practitioner (APRN)whose practice has focused on geriatrics in long term care facilities, evaluating and prescribing medications for medical and psychiatric conditions. I presently perform geriatric home assessments and physical exams in patients' homes. I can answer questions related to assisting adult children in keeping their parents at home, advising when a specialist should be consulted, advising if medications may be causing certain new problems that have arisen. Having cared for my dad with Alzheimer's for 14 years I am quite knowledgeable about what is normal and abnormal when it comes to this disease. I can help direct individuals to resources and support services that they may be unaware of. Lastly, I can make recommendations that can be brought back to the patient's doctor if he/she is willing to consider alternatives to the current treatment plan regarding a particular issue or medical problem.

Experience

I am an adult nurse practitioner with nearly 5 years experience in primary care, focusing on geriatric clients. I cared for my parents in the final 15 years of their lives interacting with healthcare providers, home nursing agencies, state agencies, Medicare and Medicaid representatives, palliative care and home hospice agencies. Prior to becoming an APRN I worked as an emergency dept. nurse for 15 years and 12 years for a large health insurance company providing medical reviews for underwriting, educating underwriters on medical conditions, utilization review and case management, requesting exceptions from medical directors to allow patients to receive medications or treatments not normally covered under their insurance plan, and I assisted in the area of reviewing complex medical claims for payment.

Organizations
CT APRN American Association of Nurse Practitioners (AANP) Sigma Theta Tau International (SITT) AARP

Publications
"Walk A Corridor in My Shoes" published in November, 2004, Nursing Spectrum.

Education/Credentials
Associate Degree in Nursing from Greater Harford Community College BSN from CCSU MSN in Nursing Management from the University of Hartford MBA from Rensselaer Polytechnic Institute MSN with Adult APRN from Quinnipiac University Graduate Certificate in Geriatric Care Management from the University of Florida Reiki Master Legal Nurse Consultant

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