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Archive for the ‘Ongoing Health Problems’ Category

I’ve written in brief about heart problems with anorexia, but it’s any eating disorder that can also produce severe heart problems. This is the hidden killer for many. I found that not knowing Sophie’s true heart rate until she was in hospital to be a very critical issue. The GP and others treating her before her first hospital admission, didn’t mention heart problems either. Nor did they do a full check on heart rate – lying down, sitting, standing. There was never a moment that they measured drop rate. They also never mentioned the heart rate overnight, when it normally drops. For those with anorexia this is very very critical. Many have their heart rate drop into emergency intensive care zones during this time and never know it. It happened to us and thousands of others. The scary side – heart failure – and not even knowing that it was getting the heart was getting that low.

As we coasted towards our second hospital admission, this time I was more than aware. Our specialist doctor did the proper heart rate tests, but I pushed our GP to do the same (and still struggled for them to understand how important this was). I also took Sophie’s heart rate late at night and in the early morning before she got up. It gave me a very real idea of what her heart was dropping to overnight, it gave me more mileage with the GP and getting her pushed onto the critical admission list.

The article below also outlines the different types of heart problems that arise with eating disorders. I didn’t know that last two and frankly, we should all be told these things regardless when we are in treatment care. I’ve put just the heart information here, but the full article that covers more general information about anorexia is available: http://www.everydayhealth.com/columns/jared-bunch-rhythm-of-life/for-both-men-and-women-anorexia-nervosa-is-increasing-and-the-effects-on-the-heart-can-be-severe/

Anorexia and the Heart

Here are four broad patterns in which the heart is affected with both short- and long-term exposure to anorexia nervosa:

1. Loss of heart muscle. Just like the skeletal muscles in your arms and legs that you can see, the heart muscle loses mass. In patients with longstanding anorexia the heart walls thin and weaken. The heart chambers then enlarge. The pumping function of the heart declines and with it, blood pressure falls. Organs that are very sensitive to blood pressure and blood flow such as the kidneys and liver then begin to fail. Fortunately with weight gain and replenishment of essential vitamins and minerals the heart muscle often recovers.

2. Abnormal heart rhythms. A number of abnormal heart rhythms can occur with anorexia. One is that the heart beats slowly, a pattern called bradycardia. This is a particular problem in people who have weak heart muscles. Normally if the heart function weakens and less blood is pumped with each beat, the heart has to increase the number of beats per minute to maintain the same average blood flow. With anorexia, if the energy stores in the heart are so depleted that the heart rhythm cannot increase to compensate for a weakened heart failure, blood pressure falls more quickly and organ failure develops rapidly.

Another concern is fast abnormal heart rhythms. People tend to be most sensitive to these types of rhythms if they follow a pattern of binge eating and purging. This can result in dangerous shifts and loss of body electrolytes such as sodium, potassium, and magnesium. The electrical aspects of the heart that create heartbeats are critically dependent on these electrolytes. When they fall, chaotic electrical patterns can develop in the lower heart chambers that result in cardiac arrest.

3. Loss of the autonomic regulation of the heart and blood vessels. Our bodies do a lot of things that we are unaware of to help us function. For example, the simple act of sitting or standing requires multiple complex changes in the body. Among these are constricting of the blood vessels to raise blood pressure, and a subtle elevation of the heart rate and contractility of the heart. In people with anorexia these reflexes can be impaired or lost. This can result in profound drops in blood pressure when attempting to sit, stand, or walk. People with anorexia can experience severe lightheadedness, fainting spells, and even cognitive changes.

4. Mitral valve prolapse. The heart valve between the upper and lower chambers on the left side of the heart is called the mitral valve. It closes when the lower heart chamber contracts to pump blood throughout the body. The changes in the heart muscle mass compared the structure of the heart valve can affect the closing of the valve. The mitral valve then can close less tightly and prolapse into the upper heart chamber. In people with anorexia about 20 percent will have mitral valve prolapse. Unfortunately, the heart valve condition appears to persist even after weight gain.

I am seeing more patients with anorexia in my clinic. To a physician, low body weight and in particular the pattern of muscle loss are noticeable signs. Most of my patients with anorexia eat a low to low-normal calorie content in a day, but then exercise excessively. Despite being very underweight they still discuss weight loss goals they hope to attain. More recently, I have encountered a surge in misuse of “natural” therapies to cleanse or purge the colon or work as a diuretic. These therapies are every bit as dangerous when misused as prescription laxatives and diuretics, and can lead to severe mineral and electrolyte depletion a

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Its been a while since I posted. Home life got complicated again and I have been swimming under the surface for a few weeks trying to find ground again. Welcome to all my new followers too. Thank you for being here and sharing our journey and sharing yours. I wish that you did not find yourself on the same horror journey we have had.

Osteoporosis and Osteopinia graphSophie had her update bone scan the other day. I found the original bone scan done 4.5 years ago during her first admission. They said then she had Osteopenia but when the doctors in Melbourne read the report and compared it with how they do their radiology, she actually had Osteoperosis. Another blackmark for regional areas, getting decent radiology reports and a GP who can bloody read them properly and not be indifferent about the number readings. Melbourne radiology has this neat way of reporting that they actually colour the bands on the results for osteopenia and osteoperosis so you can clearly see. Melbourne also do the spine and the hip. Up here they just did the spine. So we have a very good and full report of her bone health now.

So 4.5 years ago Sophie had Osteoperosis. Now 4.5 years later:

  • weight restored (3.5yrs ago),
  • with periods (been back 3.5yrs),
  • with weight bearing exercise (Taekwondo and walking),
  • and with calcium/Vit D supplements (about 6 months)

she now is still in the Osteopenia range. Its a big improvement from where she was but she still hasn’t healed her bone density yet. Our dietitian did say it can take up to 8 years to do so for some individuals. The long term damage for such a short term restriction is amazing. I shudder think if she had spent many years restricting instead of the 2 years she did, what the outcome of her bones would be.

So of course Sophie is down, being OCD/perfectionist/anxiety ridden, she has something else to fret about. However we still have about 5 years ahead of her to still build up and lay down the bone stores she will need for the rest of her life. After that she can still protect her bones by her periods, calcium intake and weight bearing exercise. Her new doctor has upped the dose of her calcium/vit D intake and will continue blood monitoring to make sure she is getting the right levels. She also gets reminded that the consequences of anorexia are long term and (hopefully) incentive to look after herself more closely than most of us do.

 

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osteoporosis and anorexiaOne of most painful episodes when Sophie was home was her outburst of: “how could you let me get so sick and get osteoporosis?”

Really?

I had to really sit on that for a while so I didn’t have a comeback at her that would have hurt her. There is so much she simply doesn’t remember nor wants to. It’s like the worst months (years) happened to someone else and she has no ability to connect with the feelings and what really did happen.

The hardest part of being a parent or carer for someone with anorexia, is having to stand on the sidelines and helplessly watch as they destroy themselves. It is even harder when your loved one is in the age group where you cannot interfer until it is too late. Anyone who has cared for someone with anorexia know just how impossible it is to get them to eat, seek help, abide by medical suggestions and care. It.just.doesn’t.happen!!!

Then of course, the long term side effects that they are left with once in recovery or recovered. It’s a case of “follow this path then there will be consequences”. So many are left with painful regrets and health problems created by their time spent in anorexia (or other eating disorders). Considering the sufferer is not responsible for causing or choosing the illness, nor are they able to respond to treatment or seek help for a long time. So it is pretty tough, when knowing you weren’t responsible for the illness, but have all the consequences of self-inflected ongoing health problems, is a bizzare place to be. It’s a cry for “not fair” but the reality is, you and you alone have to live with the consequences and try to do something about your long term health if you can.

Sophie with her osteoporosis and osteopenia is in the same position. She wants to lash out and blame someone else and be the responsibility holder. She is actually blessed in that having recovered so well so far, she still has at least 6-7 years of bone density building before her body stops doing this. She can effectively recover most of her bone damage. Others are not so blessed. Teeth, bones, endocrin system, etc can be like this forever.

After taking several breaths and some ‘out-of-house’ time, I sat her down and talked. I explained just how impossible it was to get her to eat. That we had her at the doctors within 3 months of her starting her ‘healthy’ diet. That she had ongoing weekly care from that point, and NO ONE could get her to change the path she was on. After a few days, she did come back and apologise. She still gets herself in a knot about things, still gets fears, anxieties and OCD moments about the past and the future. It is still a learning curve and learning to live and blend past, present and future.

I found this great article below about osteoporosis from ED Hope which is worth putting at the bottom of this post. It is a very clear reminder of the hidden damage that is done but also what can be done about it.

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When we think of the medical stabilization of patients with eating disorders, we tend to focus on the immediate pressing concerns:

  • Abnormal cardiac function from blood chemistry imbalances that can lead to sudden death
  • Gastro-intestinal bleeds from repeated vomiting
  • Seizures from low blood sugar
  • Other physical health concerns

Once we stabilize the malnourished patient, we need to address long-term consequences of the eating disorder that may lead to dire consequences if unaddressed.

This is particularly true for severe bone loss known as osteopenia in its earlier, less severe stage, and osteoporosis in its later more critical stage.

The Dangers of Osteoporosis

Osteoporosis is a silent, but extremely, disabling, painful condition, involving severe bone loss that can lead to:

  • Disability
  • Chronic pain
  • Loss of stature
  • Bone fractures

It is a significant health concern for 44 million Americans, and 70% of those at risk are women.  Most people think of osteoporosis as a condition of the elderly. It tends to be ignored as a potential problem in patients with anorexia or bulimia nervosa, most of whom developed their disorder in their teens or early twenties.

This is a mistake.  Even if they are in recovery, they are at a greater risk of suffering osteoporosis that in many cases could have been avoided or minimized with preventative treatment.

Women with eating disorders, particularly Anorexia Nervosa, are at high risk for osteoporosis.  About three quarters of women who meet the criteria for anorexia nervosa (those who are 85% or less of their ideal body weight), show some evidence of bone mineral deficiency.

Rest of post from ED Hope

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