Guest guest Posted April 25, 2008 Report Share Posted April 25, 2008 Hey guys...TGIF! I am seeing a 17 yr old Monday who is bulimic. Her weight appears OK. I don't see many of these patients and would like any guidance folks would like to give! Thanks a bunch! Collier, RD Clinical Nutrition Manager 9507 Hospital Avenue PO Box 17 Nassawadox, VA 23413 fax This e-mail and any attachments may be confidential or legally privileged. If you received this message in error or are not the intended recipient, immediately destroy the e-mail message and any attachments or copies. You are prohibited from retaining, distributing, or disclosing any information contained herein. Please inform us of the erroneous delivery by return e-mail. Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the company. Thank you for your cooperation. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 25, 2008 Report Share Posted April 25, 2008 Good luck!! Bulimics are the hardest to educate in my opinion. I work with eating disorders and they certainly can be a challenge. I usually start out with a history and really listen for any myths/concerns/issues that they have with food. Then, I try to discuss these myths/concerns/issues. Then, I give a meal plan (usually an exchange list type of meal plan) and go over how it can be achieved (with concerns to her eating disorder). Then we discuss how to make sure to not binge/purge. What has worked best for me is try to establish a good relationship in the beginning. This can be a challenge b/c of their distrust. Make sure she is seeing a therapist/psychiatrist. Recovery is very likely to not happen without a team approach. Good luck! Lawson, RD, LD From: rd-usa [mailto:rd-usa ] On Behalf Of Collier Sent: Friday, April 25, 2008 10:17 AM To: NEdpg ; rd-usa Subject: 17 yr old female bulimic Hey guys...TGIF! I am seeing a 17 yr old Monday who is bulimic. Her weight appears OK. I don't see many of these patients and would like any guidance folks would like to give! Thanks a bunch! Collier, RD Clinical Nutrition Manager 9507 Hospital Avenue PO Box 17 Nassawadox, VA 23413 fax This e-mail and any attachments may be confidential or legally privileged. If you received this message in error or are not the intended recipient, immediately destroy the e-mail message and any attachments or copies. You are prohibited from retaining, distributing, or disclosing any information contained herein. Please inform us of the erroneous delivery by return e-mail. Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the company. Thank you for your cooperation. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2008 Report Share Posted April 26, 2008 , There is a VERY strong relationship between bulimia and PCOS. Before getting into any cognitive behavioral stuff, I'd do a strong symptom and endocrine screen. Often times those carbohydrate cravings have a hormonal basis. Monika Woolsey www.afterthediet.com www.incyst.blogspot.com www.thisisyourbrainonpsychdrugs.blogspot.com Fertil Steril. 2002 May;77(5):928-31. Links Polycystic ovarian morphology and bulimia nervosa: a 9-year follow-up study. JF, McCluskey SE, Brunton JN, Hubert Lacey J. Department of Psychiatry, St. 's Hospital Medical School, University of London, London, United Kingdom. jmorgan@... OBJECTIVE: To examine long-term changes in polycystic ovarian morphology in women with polycystic ovaries and bulimia nervosa after treatment of the latter condition. DESIGN: Longitudinal follow-up study. SETTING: Eating disorder unit of a university hospital. PATIENT(S): Eight women originally treated for bulimia nervosa (T(0)) who underwent ultrasonography up to 2 years after treatment (T(1)) and had a second ultrasonographic scan 9 years later (T(2)). INTERVENTION(S): Treatment of bulimia nervosa that combined cognitive behavioral therapy with insight-orientated psychotherapy. MAIN OUTCOME MEASURE(S): Ovarian morphology evaluated by ultrasonography, using the criteria of to define polycystic ovaries; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of eating disorders. RESULT(S): At T(1), 7 women had recent bulimia and 1 was quiescent. The woman with quiescent disease had normal ovaries. Of the 7 bulimic women, 6 had polycystic ovaries and 1 had multifollicular morphology. At T(2), 5 women were bulimic, all of whom had polycystic ovaries. Three women had normal eating patterns and normal ovarian morphology. CONCLUSION(S): This study clearly shows a strong association between resolution of bulimia and changes in ovarian morphology, suggesting that changes in the former mirror changes in the latter. It also demonstrates normalization of ovarian morphology in previously polycystic ovaries. Gynecol Endocrinol. 2004 Aug;19(2):79-87. Links Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holtet J. Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden. .Hirschberg@... Increased amount of abdominal fat and obesity are common in polycystic ovary syndrome (PCOS). A higher prevalence of bulimia nervosa and greater cravings for sweets have also been reported in these patients. The present study aimed to compare meal-related appetite and secretion of the 'satiety peptide' cholecystokinin (CCK) and glucose regulatory hormones in PCOS women and controls. Sixteen pairs of women with PCOS and controls matched for age and body mass index participated in the study. After an overnight fast, blood samples were collected during ingestion of a standardized meal. We determined basal and postprandial blood levels of CCK, insulin, C-peptide, glucagon, cortisol, growth hormone and glucose. Self-ratings of appetite were assessed by a visual analog scale. PCOS women had a significantly lower meal-related CCK response (p < 0.05) with no association with satiety, as in the controls (r = 0.64). There was a tendency to higher ratings of craving for sweets in PCOS women (p = 0.07) but no correlation with insulin, as in the controls (r = 0.50). Within the PCOS group, ratings of craving for sweets were inversely related to testosterone (r = - 0.60) and the CCK response was positively correlated with levels of free testosterone (r = 0.50). We conclude that women with PCOS have reduced postprandial CCK secretion and deranged appetite regulation associated with increased levels of testosterone. Impaired CCK secretion may play a role in the greater frequency of binge eating and overweight in women with PCOS. Quote Link to comment Share on other sites More sharing options...
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