Sick enough : a guide to the medical complications of eating disorders

Cover......Page 1
Half Title......Page 8
Book Title......Page 10
Copyright......Page 11
Dedication......Page 12
Contents......Page 14
List of Abbreviations......Page 17
My Background......Page 20
Why Medical Complications Matter in Eating Disorders......Page 23
Who Might Benefit from This Book?......Page 24
How the Book Will Unfold......Page 25
Notes......Page 27
Not Enough Calories......Page 28
Notes......Page 30
The Cave Person Brain and Metabolism......Page 31
Starvation and the Brain......Page 33
Nutritional Rehabilitation......Page 34
Box: The “Perfect Child”......Page 35
Case: Maddy......Page 38
Background......Page 39
Getting Started with a Patient......Page 40
Orthostatic Vital Signs......Page 41
Starving Heart vs. Athlete’s Heart......Page 42
Starved Thinking......Page 43
Gastroparesis......Page 44
Gastroparesis Treatment......Page 45
Constipation......Page 47
Treatment of Constipation......Page 48
Normal Blood Tests......Page 49
Case Resolution: Maddy......Page 50
Box: The House on Fire, a.k.a. Combatting “I’m Fine”......Page 51
Notes......Page 52
Case 2: Aniya......Page 54
Background......Page 55
The Science of Bone Density Loss and Hypothalamic Hypogonadism......Page 56
Diagnosis of Bone Density Loss......Page 58
Treatment......Page 60
Exercise and Bone Density Loss......Page 63
Males......Page 64
Menstrual Periods......Page 65
Case Resolution: Josh......Page 67
Case Resolution: Aniya......Page 68
Box: Exercise during Recovery......Page 69
Notes......Page 70
Case: Maria......Page 74
Sudden Cardiac Death and Hypoglycemia......Page 75
Bone Marrow Failure of Starvation......Page 77
Liver Abnormalities......Page 78
Skin, Hair, and Nails......Page 79
Case Resolution: Maria......Page 80
Box: The Subterranean Aquifer, Checklists, and Reframing Expectations......Page 81
Notes......Page 83
Case: Jessica......Page 85
Background......Page 86
Dysphagia......Page 87
Autophonia and Lagophthalmos......Page 88
Superior Mesenteric Artery (SMA) Syndrome......Page 89
Treatment of SMA Syndrome......Page 90
Abnormal Vaginal Bleeding......Page 91
Case Resolution: Jessica......Page 92
Box: The Parables of the Fortress and the Nuclear Wasteland and the Perfectionist and the Appreciative Achiever......Page 93
Notes......Page 94
Case: Taylor......Page 96
The Hypermetabolism of Nutritional Rehabilitation......Page 97
The Refeeding Syndrome: Phosphorus and Edema......Page 99
The Underfeeding Syndrome......Page 101
Starting to Renourish......Page 102
Food Options to Manage Gastroparesis......Page 103
Nasogastric Tubes and Starting Care in a Hospital Setting......Page 104
Surgical Feeding Tubes......Page 105
Micronutrients: Thiamine and Zinc......Page 106
Target Weight Range......Page 107
Case Resolution: Taylor......Page 109
Box: The Balloon Metaphor and “Fear Foods”......Page 110
Notes......Page 112
Purging......Page 114
Notes......Page 115
Background......Page 116
Laxative Abuse......Page 117
Temperamental Factors......Page 118
Only Sick if the Potassium is Low......Page 119
Box: The Two-SidedCoin......Page 120
Notes......Page 121
Background......Page 122
Barrett’s Esophagus and GERD......Page 123
Rumination......Page 124
Parotid Glands and Face Swelling......Page 125
Effects of Laxative Abuse......Page 126
Hypothyroidism......Page 127
Sick Euthyroid Syndrome......Page 128
Case Resolution: Claire......Page 129
Box: Comparing Yourself to Your Sickest Day......Page 130
Notes......Page 131
Case: Manuel......Page 132
Background......Page 133
The Emergency Department: Life-Saving but Suboptimal for Those with Eating Disorders......Page 134
Potassium......Page 135
Bicarbonate and Chloride......Page 136
Low Sodium and Low Volume Status (Dehydration)......Page 137
Low Sodium and High Volume Status......Page 138
High Sodium and Diabetes Insipidus......Page 139
Kidney Function: Blood Urea Nitrogen and Creatinine......Page 140
Pseudo-Bartter Syndrome......Page 141
Treatment of Pseudo-Bartter Syndrome......Page 143
Box: The Sponge Metaphor and Finding Self-Compassion......Page 145
Notes......Page 146
Patients in Larger Bodies......Page 148
Notes......Page 150
Case: Janet......Page 151
Background......Page 152
Poor Medical and Surgical Care......Page 153
Health At Every Size......Page 155
Bariatric Surgery......Page 158
Resolution of Case: Janet......Page 159
Box: Naming Privilege and Challenging the Narrative......Page 161
Notes......Page 162
The Unmeasurables (a.k.a. The Very Real Medical Problems that Modern Medicine Can’t Measure)......Page 164
Note......Page 166
Case: Emily......Page 167
Background......Page 168
Treatment of IBS......Page 169
Small Intestinal Bacterial Overgrowth......Page 170
SIBO Treatment......Page 171
Pelvic Floor Dysfunction......Page 172
The Gut Microbiota......Page 173
Probiotics......Page 175
Box: The Dog in the Street......Page 176
Notes......Page 177
Case: Bella......Page 180
Background......Page 181
Three Types of POTS......Page 182
Treatment of MCA......Page 183
Ehlers Danlos Syndrome......Page 184
Medications to Treat POTS......Page 185
Chronic Fatigue and POTS......Page 186
Case Resolution: Bella......Page 187
Notes......Page 188
Specific Populations......Page 192
Case: Anthony......Page 194
Two Types of Diabetes......Page 195
Defining Some Important Concepts......Page 196
The Development of Eating Disorders in Patients with DMT1......Page 197
Prevalence and Consequences of ED-DMT1......Page 198
Managing Edema......Page 199
Choosing a Level of Care......Page 200
Notes......Page 201
Background......Page 203
Case Resolution: Jackson......Page 204
Notes......Page 205
Background......Page 206
Health Benefits of Dietary Fat and Carbohydrates......Page 207
“Clean Eating,” “Cleanses,” and Other Nonsense Fads......Page 208
A Word About Allergies, Celiac Disease, and Food Intolerances......Page 209
Treatment of Orthorexia......Page 210
Notes......Page 211
Background......Page 213
Permission to Play/Compete......Page 215
Case Resolution: Rebecca......Page 216
Notes......Page 217
Case: Martin......Page 218
Complex Causes of Eating Disorders in Males......Page 219
The Failure of the Body Mass Index (BMI) Measurement......Page 220
Case Resolution: Jorge and Martin......Page 222
Notes......Page 223
Case: TJ......Page 224
Background......Page 225
Sexual Minorities and Eating Disorders......Page 226
Gender Minorities......Page 227
Gender Minorities and Eating Disorders......Page 228
Unique Medical Considerations......Page 229
Case Resolution: Derek......Page 230
Notes......Page 231
Background......Page 233
How Do Eating Disorders Affect Fertility?......Page 234
How Does Pregnancy Influence Eating Disorders?......Page 236
Case Resolution: Angela......Page 237
Notes......Page 238
Case: Joe......Page 239
Medical Outcomes......Page 240
“Trying Recovery”......Page 241
Case Resolution: Patricia......Page 242
Notes......Page 243
Case: Shelley......Page 245
Background......Page 246
Why Do Eating Disorders and Substance Abuse Co-Occur......Page 247
Outcomes and Treatment......Page 248
Notes......Page 249
Case: Elana......Page 251
Background......Page 252
Motivating Voluntary Engagement......Page 253
Younger Patients Who Decline Care......Page 254
Guardianship......Page 255
Civil Commitment......Page 256
Older Patients Who Decline Treatment......Page 257
Palliative Care and Hospice: Defining Terms......Page 258
Hospice......Page 259
Notes......Page 261
Don’t Talk about Your Body......Page 262
Don’t Talk about Other People’s Bodies......Page 263
Exercise without Reference to Body Size and Shape......Page 264
Answer Questions with Questions......Page 265
“I Just Want My Kids to be Healthy and Not Get Teased”......Page 266
How Should I Approach a Friend Who Seems to Have a Problem?......Page 267
Creating a Safe Refuge for All Bodies......Page 268
Notes......Page 269
Acknowledgments......Page 270
Index......Page 271