A broader view of weight loss and age
Loss of appetite may be due to commonly prescribed drugs, or bereavement, low mood and isolation
As time passes, people tend to become a bit plumper, gaining a few extra pounds on average over a period of 20 years. The corollary of this remarkable stability of body weight is that there is likely to be something amiss when those in their 60s or beyond unintentionally start to lose weight. Hence the recommendation, as reported in this paper last week, they warrant “urgent investigations” to ascertain whether this might be a premonitory sign of cancer.
This is certainly a possibility, though in the absence of other symptoms suggestive of a tumour, the likelihood of those investigations yielding a positive diagnosis is very low. Thus before subjecting patients to a barrage of blood tests, CAT scans, endoscopies, X-rays and so forth, it is necessary to consider other possible explanations.
The point is well made by Dr Svetlana Stajkovic in an article, “Unintentional Weight Loss in Older Adults”, available online. The most common reason, she observes, is that the person is eating less than before – obvious enough, perhaps, though overlooked if not directly inquired about. This loss of appetite may be due to a range of physical causes induced or exacerbated by commonly prescribed drugs; irritation of the lining of the stomach (aspirin, antiinflammatories such as ibuprofen), constipation (painkillers, metformin), or reduced activity from muscular aches and pains (statins, blood pressure-lowering medication). It is important, too, to consider psychological factors where, for example, those who have suffered a recent bereavement, compounded by low mood and social isolation, are no longer motivated to prepare adequately nutritious meals.
The merits of this broader perspective should be clear enough. It emphasises the virtues of old-fashioned “holistic” doctoring, with its emphasis on taking a comprehensive history to find out what is really going on, before burdening patients with alarmist warnings that they might have cancer and the need for a panoply of intrusive investigations.
Cold comfort
This week’s puzzling medical query comes courtesy of Mrs BA of Bolton, now in her early 70s, who reports that for as long as she can recall she has been troubled by recurrent “colds” throughout the winter months – four so far this year. They start unusually with what sounds like an acute allergic reaction, running eyes and a torrent of clear watery nasal discharge “so excessive I can only walk about the house with a tissue plug pushed up my nostrils”, she says.
These initial symptoms then morph into a typical upper respiratory tract infection with fever, nasal catarrh, a productive cough and impaired hearing. None of the usual remedies, both conventional (paracetamol, antihistamines) and “complimentary” (vitamin C, zinc, golden seal root) influences the severity or duration of these episodes, which can last for up to four weeks.
She would more than welcome any suggestions from those with a similar experience.
Meditation marvel
Finally, further to the intriguing phenomenon of mind over matter, as recently touched on in this column, a reader reports the unexpected effects of his decision in his mid-50s to devote half an hour a day to “prayerful meditation”. Reviewing his efforts after six months, he felt nothing much had altered, but gradually he noted changes “of a physical rather than a mental nature”. His periodic episodes of crippling back pain became less frequent before ceasing altogether. Next, a chronic eczemalike condition of the hands brought on by contact with lubricants during his time in National Service went into remission. Then two long-standing chronic fungal infections of the feet and scalp resolved themselves. While the medical treatments he sought over the years had certainly worked, they could scarcely be described as curative in the same way as the effect of his meditative state.