Right Before Our Eyes
EMS 1 had just taken a sixteen-year-old girl to the Cardiac Room, and transferred her to our stretcher. The paramedics had called in a report of “unresponsive and no pulse” and nothing had changed before their arrival.
There was a flurry of organized chaos surrounding her bed as our team worked to get the teenager stabilized. She was skinny to the point of being wasted, and I wondered if she had some form of cancer.
Her mother had followed the EMS team into the room and I turned to her. “Does your daughter have some serious illness? Cancer or kidney failure? Any medical problems?”
The woman stiffened and her eyes narrowed. “Cancer? Of course not! Kylie’s been perfectly fine until…maybe the last couple of days. She just hasn’t seemed herself.”
“Heart rate is 52,” one of the nurses told me. “I can’t get a blood pressure.”
My eyes studied the woman’s face, trying to find some opening, some chink in this wall of denial.
“We’ll need to talk,” I told her, then spun around to her daughter. “Get lab down here, and X-ray!”
. . .
Eating disorders are all-too-common, with their prevalence increasing every year. Now that number is a little more than 3 out of every 100 people. May not sound like many, but the prevalence of appendicitis—something we all worry about—is only 1 out of 400. These disorders include several specific diagnoses, with the most common and familiar being anorexia nervosa and bulimia. Of those two, anorexia is the more serious and the more deadly.
We’re not sure where these things come from, or what triggers them. One common denominator appears to be an unnatural and unhealthy perception of self-image, which can be manifested as early as in the pre-school years. Whatever the cause, it’s multi-factored, and includes family dynamics as well as peer and social/media interaction.
And it’s real. Unrecognized and untreated, these disorders can lead to heart muscle atrophy, other serious cardiac problems, osteoporosis, growth disturbance, life-threatening electrolyte abnormalities, and suicide. The diagnosis can be difficult and delayed, mainly due to that wall of denial I mentioned. This can be encountered with the young person themselves, or with their parents. However, there are a few tell-tale signs we need to be aware of, especially with bulimia. The frequent self-induced vomiting will produce callouses on the backs of several fingers (from eliciting a gag reflex) as well as a wasting away of the enamel of the teeth from exposure to the acid contents of the stomach. And then there’s the weight loss, which can be gradual and difficult to notice if you’re seeing your son or daughter every day. That’s another important point—with many of these disorders, contrary to common thought, the incidence in boys is the same as in girls. You just have to be aware.
Fortunately, we have a couple of tools that can help us with this diagnosis, or at least raise some red flags. The SCOFF questionnaire is simple and accurate enough to be an initial screen. If you’re concerned about this possibility, here are the questions that you should ask your child, or answer them from your own observations.
- Do you make yourself Sick (vomit) because you feel uncomfortable?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost Over 14 pounds in a three-month period?
- Do you believe yourself to be Fat when others say you are thin?
- Would you say that Food dominates your life?
Two or more positive answers is cause for concern and is very frequently indicative of the presence of an eating disorder. If that’s your child’s score, get some help, and get it quickly.
For Kylie, that help came too late. She died two days later in the ICU, her mother still in denial.
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