Brief Answer:
Occasional nutritional IV supplements can be taken

Detailed Answer:
Hi XXXX
Thanks for asking.
I went through the present and previous query and my opinion is as follows:

1. Diarrhea due to IBD is common and will be limited to few episodes. It would affect the nutrition, but not enough to explain previous weight loss. Give her good amount of fluids as she as diarrhea episodes.

2. Fluctuating weight of 99-104 is ok, even though both of us want it high. Weight fluctuates in relation to water content of body and also has diurnal variation. If it is around this, nothing to worry at present.

3. The weight will increase in due course as her nourishment improves. Try all available methods as explained during our previous query.

4. The weight is adequate for a 5 feet person, and if she is bit more, she will be in the malnourished category. As she is just now in your care for the past month, it will take time.

5. Importantly give her good amount of fluids during daytime along with multiple small meals.

6. At present, she is completely independent and managing herself. IV supplements are necessary when she cannot take anything through her mouth. I would not advise to her, as once IV supplements starts full time means, she is in critical condition. It would affect her morale and adverse cycle would start.

7. If necessary occasional vitamin or other nutritional injectables can be given to improve nutrition. No complete IV supplements, as she is still hale and healthy and will definitely recover with good support. IV supplements will be your last course, as opening a venous route for food, can introduce infections too and complicate further. There are numerous complications to follow IV supplements completely.

8. The bone mineral density test definitely indicates osteoporosis. If she were 65 or even 75 with good weight, i would have started on osteoporosis treatment. At 84 years and with other problems at present, I would ask you to go a bit slow.

9. The risk of fracture is very high, more at the hip. Present priority indicates to gain weight and improve nutrition. So to reduce fracture risk at present, you can try to make her surroundings elderly friendly -
a. Reduce risk of slipping and tripping (proper shoes, care with steps, slippery surfaces, well lit areas)
b. care at night especially, no dim lit areas.
c. Use of walking stick and other supports.
d. If possible, padding around hips to reduce fracture risk, if she falls.
e. Mobility should be slow, deliberate without any sudden movements.

10. The bone density scan results are indeed serious, and at this age, osteoporosis treatment effect would be limited. Low nutrition would not help in improvement. Anti-osteoporosis drugs effect would be limited due to malnutrition and side effects of drugs will be unpredictable and further hamper present recovery. Once she recovers to 130-140, further thought may be given.

Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM

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Brief Answer:
Below ideal weight, will improve with care.

Detailed Answer:
Hi XXXX
Thanks for replying.
Her weight is comparatively low for height and she is mildly below the ideal weight. A 10-12 pound increase will get her back to normal.
You are absolutely right in saying that stress is the major cause for her present condition. She requires good support from you and others surrounding her.

Moving around and interacting with others, should reduce stress. You need to concentrate on her diet to improve her weight. Other issues would solve itself.

You need not worry about irritable bowel syndrome. It wont affect her weight. Irritable bowel syndrome would affect usually the fluid load. You can give more fluids to her. Reduced intake would be the major reason. Try to give more weight gaining foods along with oral nutritional supplements.

Any further queries, happy to help again.

Dr. Prakash HM

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