WEIGHT LOSS

    In medicine we do vital signs as a routine part of examination. That includes pulse , blood pressure , respiratory rate and temperature . Now a days we have started adding oxygen saturation. and height and weight are also standard to be recorded for each visit. One of the things that I have noticed is that in many offices these things are checked not by physicians but by assistant. I think that sometimes is a problem as weight change is not quickly noticed ,especially  if the BMI is normal. That brings me to the story for today. 

    I have known and seen this patient for last 20 years or so. She was a 70 plus years old female who had a diagnosis of Narcolepsy . And she has been treated with medicines and has been stable on medicines . She also had chronic cough and I did work up and could not find any cause for that. I treated her with different medicines like asthma inhalers and medicines for GERD - reflux of acid and allergies and she still had cough. Over period of time it was better and she was doing fair . Then she started losing weight .  

I noticed it and asked her about it . She was not on any medicines and had no other complaints. She had no gastrointestinal complaints. Normally we worry about cancer  and so we do routine work up for GI . She had CT scan of abdomen and saw Gastroenerologist and they could not find any cause .She came back to me . She had also seen neurologist as she had some weakness and needed walker to walk as had fear of falling. The neurologist did some tests and wanted her to see a different neurologist for  Myasthenia Gravis . The blood test for that was negative . She got appointment in 2 months . She came to me with her daughter. She had continued to lose weight and  so the daughter was concerned . 

    I have seen her for several years and knew that she was losing muscle mass and had lost 40 plus pounds of weight. I told her that she needed a muscle biopsy to find out what was going on. She agreed . I called a surgeon to see her soon and do the biopsy . 

  He did the biopsy in less than 2 weeks and the result was something that I had not known or seen before . She had myopathy but the type that she had was not known to me and so i told her to talk to the neurologist and he also had not known much and she was asked to see a nearby university center neurologist. 

   Weight loss is good when it is due to diet - exercise . But if it is way out of proportion to the change in diet and exercise then it needs to be worked up. If the weight loss is unintentional ,then IT MUST BE WORKED UP and sometimes we come across diagnosis which is rare and may be nothing can be done ,but at least we have the diagnosis.