58 year old Margaret has lost 25 pounds in the past 4 months. Just don't have an appetite she explains, I prepare meals for my husband and start to eat, but then feel nauseated and can't continue. She never vomits and has no history of recent trauma or depression, though today she appears depression (but of course what part is antecedent depression, or depression from uncertainty about her weight loss, or simply weakness from malnutrition?)In the midst of an extensive work-up for this, I was consulted because of an incidental finding on an abdominal CT--the uterus looked a little funny. The uterus was fine, I decided, so my services were no longer needed.
But I thought I'd throw in my two bits: for example, protein shakes, sipped every hour or so throughout the day, with no expectations of sitting down and eating a full meal. I thought about, but decided against discussing marijuana, known for it's anti-nausea effects for patients with chronic illnesses such as AIDs or cancer or who are undergoing chemotherapy.
Her evaluation needs to be completed first, and then such a suggestion should come from her primary care team who knows her best and has her trust and confidence. Still, though, what if no one else suggests what could be a significant, even life-changing treatment?
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