Brief Answer:
Good Morning and Welcome to HealthCareMagic

Detailed Answer:
My dear, you are stressed! I am not going to say this is the only reason for your weight loss, but stress can cause you to drop pounds like that, I have seen it.

Next, I am concerned that your thyroid may be overactive. I suggest a full thyroid panel. When was the last time you had one done? TSH, Free T4. I also suggest that with your malnutrition, you have a CBC done to check for anemias.

I do not see that you are on an anti-depressant. Individuals suffering from chronic pain are most frequently treated with psychotherapy and medication. In fact, some pain clinics require it. Duloxetine is used for pain, anxiety, fibromyalgia and depression.I suggest you counsel with a therapist about whether this might benefit you. Even CDC recommends that duloxetine be considered in anyone with chronic pain receiving opiods.

I must address your weight as you can no longer wait to get working on this. You are 16.5 for BMI. Anything 16 or less is severe malnutrition. For my patients this malnourished, I would suggest an oral supplement with vitamins 3x per day, a product high in protein, 1 cal/ml. You need to gain weight, but do so slowly to avoid a condition called refeeding syndrome. Please read further on this syndrome, do you have a computer?

Add foods with healthy fats in them to your meal plan. Slivered almonds, chopped walnuts, use virgin olive oil to make salad dressings and stay away from saturated fats. Drink whole milk and use full fat dairy products. Basically, don't try to "control" your weight until it has stabilized then strive to maintain a realistic weight. The weight you put back on - strive for more muscle than fat. How? Increase lean proteins, and remain active. How much protein? A minimum of 53 grams per day - 65 grams/day.

Take a walk 30 minutes a day when possible. Try to deal with your anger and stress with exercise, not strenuous but invigorating.

You asked about IBW. The IBW for you would be 145 lbs minimum. Normal BMI is 18.5-25.

Avoid iodized salt, any supplement with iodine in it and no extra selenium. try to avoid extra of these nutrients in multivitamins or oral supplements as both these may stimulate your thyroid gland and until everything is checked out, I don't want your thyroid overacting as I think it may be. When was the last time you has a free T4 and TSH done?

Again, in summary,
1. See doctor, have TSH, free T4,CBC done and other labs as deemed necessary by doctor
2. Supplement your diet with an oral product containing high protein.
3. Multivitamin or vitamins in oral supplement
4. No supplemental iodine, selenium
5.Consider duloxetine
6. Get daily activity
7. Avoid refeeding syndrome by gaining slowly
8. No more weight loss, this is serious

With regards to your husband, if vascular dementia should be tested for diabetes and diet controlled/meds added as needed. Namenda works wonders with some dementia patients - it has a different mechanism of action than all the other dementia medications. Assure that he does "brain games" every day to encourage him to retain what mind he has. Help him when he needs help, but don't enable him. You might want to look into a support group for people in the same boat as you in dealing with dementia. It's hard. No two ways about it.

You are a strong woman. Draw on that strength and take care of yourself.

I truly hope I have given you some ideas. Best of Luck. XXXXXXX Shattler, MS,RDN

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Brief Answer:
So happy that I have helped and one more thing

Detailed Answer:
Good Morning!

I was hoping I could help. I wanted to mention that the duloxetine has a side effect of decreasing appetite and weight loss. However, I didn't feel loss of appetite was your problem. However, if you do experience any side -effects if your doctor chooses this medication there is another option. You can add on periactin, which is an appetite stimulant and given to people who have lost weight because of no appetite. Your doctor should know, cut I will lay it all out just in case. Duloxetine is
your best choice in this situation.

Furthermore, add your oral supplements in between regular meals gradually with one per day then add two per day then 3. Did you happen to look up refeeding syndrome?Generally, in case your doctor is not familiar with this, I will outline what I would do:
Check blood calcium, magnesium, potassium and phosphate
Before feeding starts: administer thiamine 200-300 mg orally
1-2 tablets B complex 3x per day for first week
Multivitamin every day
Monitor calcium, magnesium,potassium, phosphate once per week for two weeks

And yes, save these answers on your computer and take them to your doctor.
You can cut and paste into word and save the file if you like or just print out the email correspondence.

You have started my day out on a good note knowing I have helped you! Good luck to your husband as well! XXXXXXX Shattler, MS,RD

PS. Administration says: Don't forget to close the question out and rate it! :)

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