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Losing weight. Medical test fine. Feeling headache, tired, nausea and appetite. How to maintain health?

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Practicing since : 1981
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Hello, my sister is losing weight unintentionally, she is struggling to keep the weight on. She is weighing on 38kgs and is 24yrs old!!! We have been to numerous doctors and Physicians per the past few week,, and TWICE to the ER, they have done CBC, Thyroid Function, Cortisol, Liver Kidney. but all is fine as they say... She is FORCE FEEDING herself just so that she does not drop any further in weight. She has CONSTANT Headaches and IS UNABLE TO WORK anymore, as since this weight loss began, she has become CHRONICALLY TIRED, she used to shop for hours and walk, but now she can't even have enough strength to dress herself. I AM SCARED, doctors just keep ignoring us. I will show you pictures of how she look 3 months ago, she was lively, look healthy she is looking gaunt and it is worrying us all. When the weight was dropping off, she ATE a lot even had MRP's in-between, but it just fell off. Now she has chronic nausea and no appetite, but still forces food down, and has to takes anti nausea tablets daily....The doctors are not helping can a lively 24yr old just become almost bedridden and loose so much weight. WE ARE 300% sure she is not bulimic or Anorexic..GUARANTEED. She complains of acid reflux and mucous in the throat and nose, as well as a nausea and discomfort radiating from her central abdomen(just below the ribcage, in thee center of the torso). She also has severe hard like muscles on her shiulders as if it is knotted, her right sholder seems to be in spasm?? Also she has been comaning of feeling feverish, And that her arms are weak. For that past couple months she seems to have knee troubles, and can finds it painful to walk down stairs etc. She has had a negative XXXXXXX to rule out Lupus. Please help as it it now two months and she is no longer the healthy sister i knew... Please help us.....From a concerned brother. PS we are in Johannesburg South Africa
Posted Sun, 5 Aug 2012 in Weight Loss
Answered by Dr. Anil Grover 2 hours later
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology. I read your question with diligence.
When you mention she is not having anorexia or bulimia I take it that her appetite is normal. I also noted with concern that no cause of weight loss has been detected so far.
With a weight of 38, I will not blame her for becoming chronically tired and having headaches.
Clinically to me she appears to be case of malabsorption syndrome. As per the information given by you in the mail, you have not mentioned tests for malabsorption. She needs, stool fat test, breath test and other tests which your doctor feels help us in reaching the cause of the problem. Once it is estabslished that she has malabsorption or major nutrient(s); we will where to look for etiology for this. It could be many a things which cause malabsorption and most are simple treatable. Let us hope for the best. Regards.
I will urge you to see your doctor with this suggestion. If you have any other query, I will be most happy to answer.

With Best Wishes

Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: Losing weight. Medical test fine. Feeling headache, tired, nausea and appetite. How to maintain health? 2 hours later
Thank you kindly for the response Dr. I had demanded this to the Dr when I took her to the ER a month ago. The Dr responded that she did not have malabsorbtion as her blood tests showed normal levels of fats and proteins etc. however one must realise that at this time she had been consuming a diet that was her 3 meals per day including MRPs like Ensure ans Lifegain inbetween, so her food consumtion was much higher, so i was thinking that if she returned to a normal diet, perhaps the blood and fats in the blood would decreaze below normal... I wAs ignored. I recommened to the Dr that that they shoulc check for things like celiac or chrons and they did an IGn test and it came up just above normal i.e 108 and the spec was 1-100. I was also thinking things like a parasite like tapeworm etc but the blood eonsophils were normal and the Dr said they would be raised if a parasite was present. She as of now has an appetite that comes and goes due to the nausea and headaches but she is still forcing herself to eat to keep on some weight. Theblood procfile as of recent included tests for iron, ferratin, b12, fasting glucose all were normal except a high normal for iron. She remains at hime wasting away and does not want tovisit drs anymore as she says they are failing her. Any direction forward would be appreciated:
Ps just to add to my second response to you above the Dr also performed a C- reactive protein and erythrocyte sedimentation rate and both were normal actually very very low, does this exclude a diagnosis of malignancy?
Answered by Dr. Anil Grover 51 minutes later
Thanks for your reply/query. It raises more questions. Firstly ESR and CRP do not reflect absence of malignancy, no tests in the blood per se confirms mal absorption. If her consumption is being maintained at the level you say it is and she is loosing weight where all the nutrients going? Logically, there is either problem with absorption which tests like stool fat (>75 G per day) will tell or tests for diseases which leads to excessive metabolism like hyperthyroid will tell. How to plan a investigative work-up is by any qualified physician after taking history and doing a general and systemic physical examination. If there is lack of rapport with first primary physician could you request (it hurts ego so be polite) for a second opinion or ask for a specialist opinion gastroenterologist or endocrinologist are best sub specialists in the situation you have describe. Please do not despair. There ought to be a way to get her diagnosed like showing to another hospital a university hospital/teaching hospital. Furthermore, she is not in position to take care of herself, and we have not reached a stage where we have found incurable disease, she expects hope from you not despondency or anger. If you have any query I will be to answer happily. I wish I could do more.
With Best Wishes

Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
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