Unexplained Weight Loss Despite Normal Diet: Seeking Medical Guidance

Normal diet, but the body is becoming increasingly emaciated?

Hello Dr.
Chen, I am inquiring on behalf of my mother-in-law.
Since after the Lunar New Year this year, she has been losing weight continuously.
She originally weighed 48-49 kg, but now she is down to 43 kg.
She eats about half a bowl of rice at each meal, but her diet is quite bland due to inflammation of the salivary glands, which makes her mouth feel very acidic.
Recently, her meals have been without soy sauce (as advised by her doctor to avoid fermented foods).
She has undergone an endoscopy, which showed inflammation in her esophagus and stomach, and she has been on medication for treatment.
Her bowel movements are normal, but she still feels unwell.
When she lightly touches above her navel (the area of the stomach), it is painful, and she also reports feeling a hard lump.
We are unsure which specialty to consult! The endoscopy only indicated inflammation! My mother-in-law has several health issues, including mitral valve insufficiency (she had surgery, but it was unsuccessful), kidney stones (confirmed by MRI), cervical spine osteophytes, right shoulder inflammation leading to adhesions, periodontal disease, and menopausal insomnia (she takes sleeping pills but wakes up early in the morning and cannot fall back asleep).
Aside from her heart condition, the other issues began at the end of last year.
We are unsure if this is related to long-term medication use.
Please help us understand what specialty she should see, as she seems to be eating but is unable to absorb nutrients properly.
Thank you.

Jamie, 30~39 year old female. Ask Date: 2017/05/22

Dr. Chen Taicheng reply Family Medicine

The causes of involuntary weight loss in the elderly are numerous.
For instance, 1.
Side effects of medications.
2.
Emotional issues, such as depression.
3.
Poor appetite, which can occur with normal aging, such as diminished taste, delayed gastric emptying, and gastrointestinal digestive issues.
4.
Swallowing and oral problems, such as those caused by stroke, Parkinson's disease, or dementia, leading to swallowing difficulties or issues with missing teeth or ill-fitting dentures.
5.
Endocrine problems, such as hyperthyroidism or abnormal blood sugar levels (diabetes).
6.
Other causes, such as infections or malignant tumors.
Please first determine if the lack of soy sauce in her diet is causing her to eat less, and also manage any chronic diseases or potential pain issues.
Additionally, it is important to rule out thyroid and diabetes-related problems.
Please visit a geriatric medicine specialist for further evaluation.
If there is a suspected abdominal mass, please consult a gastroenterologist for confirmation.
Due to the multitude of possible causes, please inform your mother-in-law to be patient as we work to identify and address the underlying issues.
Wishing your mother-in-law good health, Dr.
Chen Tai-Cheng from the Family Medicine Department at Taoyuan Hospital is here for you.

Reply Date: 2017/05/22

More Info

I'm sorry to hear about your grandmother's health issues. Given the symptoms you've described, it sounds like she is experiencing significant weight loss and discomfort, which can be concerning. Unexplained weight loss, especially when accompanied by other symptoms like abdominal pain and a history of various health conditions, warrants a thorough medical evaluation.

First, it's important to understand that weight loss can be caused by a variety of factors, including metabolic disorders, gastrointestinal issues, chronic diseases, or even medication side effects. In your grandmother's case, her history of heart valve issues, kidney stones, and other ailments complicates the situation. The fact that she has been experiencing pain in the upper abdomen and has noted a hard lump could indicate a more serious underlying condition that needs to be addressed.

Given her symptoms and medical history, I recommend that she see a gastroenterologist. This specialist can further evaluate her gastrointestinal health, especially considering her recent gastric inflammation and the ongoing issues with her salivary glands. They may suggest additional tests, such as imaging studies (like an ultrasound or CT scan) to investigate the hard lump you mentioned, or further endoscopic evaluations if necessary.

Additionally, it might be beneficial for her to consult with a geriatrician, who specializes in the health care of older adults. They can provide a comprehensive review of her medications and health conditions, as well as assess her nutritional status. Sometimes, medications can lead to side effects that affect appetite and nutrient absorption, which could explain her weight loss despite eating regularly.

In the meantime, it’s crucial to ensure that she is receiving adequate nutrition. If she is struggling with her diet due to her oral discomfort, consider consulting a nutritionist who can help create a meal plan that accommodates her needs while ensuring she gets the necessary nutrients. Soft foods or smoothies might be easier for her to consume and digest.

Lastly, keep a close eye on her symptoms. If she experiences any new or worsening symptoms, such as increased pain, changes in bowel habits, or signs of dehydration, seek medical attention promptly. It’s essential to address these issues as soon as possible to prevent further complications.

In summary, your grandmother should see a gastroenterologist for her gastrointestinal symptoms and consider a consultation with a geriatrician to review her overall health and medications. Ensuring she receives proper nutrition is also vital during this time. I hope she finds relief soon and that her health improves.

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