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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by CareBear04 on March 18, 2005, at 16:13:48
Dear Dr. Steinhauer,
I was wondering whether you could comment on the connection between weight and blood pressure. I know there's a correlation at the high ends-- obesity and hypertension-- but what about at the other extreme?
I'm a 22-year old female with baseline BP between 110 and 120 systolic. I've always been a little underweight but otherwise healthy. In the fall, various circumstances caused me to lose about 15 pounds, placing me at a BMI of around 15. Since then, my BP has been no higher than 90 systolic, usually between 70-80, even though I've gained back most of the weight I lost. At first, I was always really dizzy, but I think my body has adjusted. I'm not so lightheaded, and I'm able to be pretty active. I have trouble standing still for very long, but I can walk and swim, and I drive short distances. The major concern has been passing out, which has happened several times. The last instance was about three weeks ago, but as long as I remember to get up slowly, I'm usually fine.
During this time, my pulse has, if anything, been too fast. I don't know if this is a natural compensation for the low BP or whether it's med-related (I take Adderall, Concerta, and Prozac among others). Recently, I've also started having bad tremors that are unlike the tremors I'm used to from lithium. They involve the whole body and feel like the shakiness associated with low blood sugar, but I've been eating small meals frequently.
Should I be more concerned about these problems? And is there any suitable treatment for them? I see my psychiatrist 2x a week (and am cutting back to once a week), my PCP once every two weeks, my physical therapist 2x a week, and other doctors about once a month. I also have to get labs drawn once a week. It all adds up to a lot of time, and I'm tired of all the appointments. Also, have you ever known medical supervision of weight to be detrimental? The frequent weight checks and all the outside pressure to eat more-- something I am already trying to do-- make me want to do the opposite, though I've been consistent with weight gain. I feel medically and psychologically stable, and I'd like to feel more autonomous and less supervised. What sort of monitoring and frequency of visits do you think is appropriate? I'm sure the recommendation depends on more details than I've provided, but I was hoping you could give me a general idea. Thank you so much!
Posted by Racer on March 18, 2005, at 22:26:37
In reply to Steinhauer-- low weight problems and doctors, posted by CareBear04 on March 18, 2005, at 16:13:48
Just a quickie: the N I'm seeing has done more for me in the four and a half months I've been seeing her than all the psychological treatment I've had for any of this. She's made a huge difference.
If it hasn't been suggested to you before, I suggest you ask your doctor or psychiatrist about it.
Hope that helps.
Posted by Dr. Beth Steinhauer on March 19, 2005, at 19:00:53
In reply to Steinhauer-- low weight problems and doctors, posted by CareBear04 on March 18, 2005, at 16:13:48
Dear Care Bear,
Based on what you've written, I would be very concerned about your medical status. You didn't indicate your current BMI, but a BMI of <16 is almost invariably cause for immediate hospitalization and refeeding. It sounds as though you may be experiencing many effects of starvation, including low blood pressure, postural hypotension (that means that your blood pressure drops when you sit or stand up after lying down), (possibly postural) tachycardia, dehydration, dizziness, syncope (passing out). When you write "I'm not so lightheaded", it sounds to me as though you've become desensitized to how abnormal your medical situation must be. Fainting three times in recent weeks suggests that your body is seriously underweight, malnourished, dehydrated, or all three. (There are plenty of other reasons why adults get dizzy, but I'm speculating based on your eating disorder history and your age and recent low weight.) You SHOULD NOT be driving under these circumstances, as you are endangering yourself as well as other pedestrians and drivers. When your BMI is restored to >/=18.5 and you no longer faint or feel dizzy, THEN you can safely resume driving.The fact that your treatment team is requiring this intensity and frequency of visits suggests to me that they are very concerned about your emotional and physical health. While it is common for people with A.N. to chafe against frequent weight monitoring, often believing it makes them feel worse, I agree with your team that this level of supervision is necessary. I suspect that part of your illness involves minimizing or denying the seriousness of your symptoms. This, too, is unfortunately typical of most underweight people with A.N.
For what it's worth, I worry too about your use of two stimulants, Concerta and Adderall, in light of your eating disorder history. I hope that your psychiatrist is well aware of your weight, blood pressure, etc.
Take good care of yourself, and feel free to share what I've written with your treaters. ES
Posted by CareBear04 on March 22, 2005, at 2:52:26
In reply to Are you seeing a nutritionist?, posted by Racer on March 18, 2005, at 22:26:37
hi racer-- thanks for the suggestion. it's something i looked into seriously in the fall. at that point, i was losing some weight, and it concerned me, but medical training does not apparently teach doctors anything about nutrition. and my insurance for some reason will not cover nutritional consultations except in the case of diabetes. i don't pretend to understand the nuances of what is acceptable and what is not. i pretty much gave up on seeing an outpatient nutritionist. When I've been in the hospital, twice between November and now, the nutritionists or trainees there were more than willing to help and gave me stacks of stuff about adding calories, making things more nutritious, etc. Now, aside from my PCP and pdoc, i'm also seeing a physical therapist. before that, i went to get acupuncture for nausea and stomach pain. i guess what i'd like most is for the physical therapist and the nutritionist and the doctors to work together to plan an activity regimen and the proper food to take in before exercising. As far as the nutritionist herself, my insurance doesn't cover and i probably couldn't pay. LEt us know how things are with your nutritionist,
Posted by Racer on March 22, 2005, at 16:06:32
In reply to Re: Are you seeing a nutritionist? » Racer, posted by CareBear04 on March 22, 2005, at 2:52:26
Actually, most insurance plans won't cover seeing a nutritional counselor for WEIGHT LOSS -- it takes a little bit of "reminding" them that they do cover it if it is "medically necessary" -- although you may have to talk to your doctor or psychiatrist to get them to refer you formally. But I would bet that your doctor can get it cleared for you.
Good luck.
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