Mysterious weight loss
December 9, 2018 12:01 AM Subscribe
I've lost about 20 pounds in the last eighteen months. I don't know why. I have a cooperative doctor who will run tests if I suggest them but doesn't do a lot of suggesting herself. What's the next thing I should try?
I've run a number of tests already. Most notably, my thyroid and sugars both came back clean, more than once. My blood tests have been mostly clean (low iron, elevated ESR) and I don't have B12 deficiency. I had a chest x-ray that looked fine and a stool sample that turned up negative for whatever the standard battery of parasite tests were. I had a recent gyno exam that was also normal. I don't have any other symptoms and I'm 30.
What is the next test I should be running? What should I be doing to figure this out?
I've run a number of tests already. Most notably, my thyroid and sugars both came back clean, more than once. My blood tests have been mostly clean (low iron, elevated ESR) and I don't have B12 deficiency. I had a chest x-ray that looked fine and a stool sample that turned up negative for whatever the standard battery of parasite tests were. I had a recent gyno exam that was also normal. I don't have any other symptoms and I'm 30.
What is the next test I should be running? What should I be doing to figure this out?
I agree with pazazygeek. Unexplained weight loss of over 10 pounds in 6-12 months, or over 5% of your body weight, is supposed to be taken seriously.
It's your doctor's job to figure out what tests to run, not yours. If you're able to switch doctors, I'd really recommend it.
However, if you are not able to switch doctors (and I know it's not possible sometimes--I'm in that boat myself), here is the bare minimum of tests they should be ordering:
posted by hurdy gurdy girl at 1:28 AM on December 9, 2018 [10 favorites]
It's your doctor's job to figure out what tests to run, not yours. If you're able to switch doctors, I'd really recommend it.
However, if you are not able to switch doctors (and I know it's not possible sometimes--I'm in that boat myself), here is the bare minimum of tests they should be ordering:
In most cases of significant unintentional weight loss, a basic laboratory workup should be performed. Even if there is a leading diagnosis after the initial history and physical exam such a workup is prudent as many patients who present with unintentional weight loss are older and have risk factors for malignancy and cardiovascular disease. For example, an older patient with unintentional weight loss may be diagnosed with depression, but may also have an occult malignancy as a comorbid condition.As you can see, this kind of unexplained weight loss is considered serious shit, because although it does not always mean something life threatening, it can, and it is often something that needs treatment in order not to become something more serious. Your doctor really, really needs to get much more proactive about this.
The basic initial laboratory workup should include the following:
- CBC
- Serum electrolytes
- Serum glucose
- Serum calcium
- Blood urea nitrogen/serum creatinine
- Urinalysis
- LFTs
- Serum albumin
- Thyroid stimulating hormone (TSH)
- Stool heme test.
HIV serology should be ordered if the patient has risk factors for HIV infection. It is also reasonable to complete age and risk-factor appropriate cancer screening (e.g., colorectal, breast, cervical) if not already done.
posted by hurdy gurdy girl at 1:28 AM on December 9, 2018 [10 favorites]
I agree. Unexplained weight loss can be an early sign of something serious, and it should be investigated aggressively. I have a feeling that if you were male, your doctor would be taking this more seriously. Society tells us that women should always be trying to lose weight, and doctors (even female ones) are not immune to those messages.
There are too many possibilities here for internet strangers to be able to give you meaningful advice. It could be anything from a lifestyle change that you haven't considered to Actual Cancer, with literally hundreds of possibilities in between spanning categories as broad as autoimmune disorders, age-related changes, and psychiatric conditions. I strongly recommend that you push your doctor to investigate this in more depth, or else to find a doctor who will. Perhaps your PCP can refer you to a relevant specialist, or perhaps you need a second opinion from a different PCP.
posted by Anticipation Of A New Lover's Arrival, The at 3:47 AM on December 9, 2018 [3 favorites]
There are too many possibilities here for internet strangers to be able to give you meaningful advice. It could be anything from a lifestyle change that you haven't considered to Actual Cancer, with literally hundreds of possibilities in between spanning categories as broad as autoimmune disorders, age-related changes, and psychiatric conditions. I strongly recommend that you push your doctor to investigate this in more depth, or else to find a doctor who will. Perhaps your PCP can refer you to a relevant specialist, or perhaps you need a second opinion from a different PCP.
posted by Anticipation Of A New Lover's Arrival, The at 3:47 AM on December 9, 2018 [3 favorites]
I'm a GI doc. To be honest, I find it a bit concerning that your doctor is "cooperative" instead of developing her own workup plan.
There are well known guidelines for evaluating iron deficiency and even though investigating weight loss can be tricky, the low iron and elevated ESR are useful information that any family physician or internist should have a fairly good idea what to do with.
I'd ask her to develop a plan or refer you to someone who will.
posted by M. at 6:25 AM on December 9, 2018 [10 favorites]
There are well known guidelines for evaluating iron deficiency and even though investigating weight loss can be tricky, the low iron and elevated ESR are useful information that any family physician or internist should have a fairly good idea what to do with.
I'd ask her to develop a plan or refer you to someone who will.
posted by M. at 6:25 AM on December 9, 2018 [10 favorites]
FWIW, about two years ago, I suddenly lost around 30 pounds in the same timespan as you. It coincided with a brief period where I was becoming easily sated at meals. As in, take a few bites and immediately feel stuffed. My docs (a GP and a gastroenterologist) ran tons of tests and scans on me and found nothing wrong.
They did multiple imaging runs on me, extended radioactive screening, blood tests, etc. Nothing. Zilch. The only thing that was even notable was my stomach was emptying juuuuust a bit slower than the gastro guy thought it should, but it still wasn't anything he considered serious, and definitely not something that would have explained the extreme weight loss.
Eventually, the "easily sated" condition went away. My weight stabilized, and I can now eat normally, though I've not been able to gain any weight back.
The biggest downside to it all was that the initial weight loss was so sudden and so quick that I lost a ton of muscle mass, which is not easily regained, if it can be at all.
To this day, no one knows why it happened.
posted by Thorzdad at 6:25 AM on December 9, 2018 [1 favorite]
They did multiple imaging runs on me, extended radioactive screening, blood tests, etc. Nothing. Zilch. The only thing that was even notable was my stomach was emptying juuuuust a bit slower than the gastro guy thought it should, but it still wasn't anything he considered serious, and definitely not something that would have explained the extreme weight loss.
Eventually, the "easily sated" condition went away. My weight stabilized, and I can now eat normally, though I've not been able to gain any weight back.
The biggest downside to it all was that the initial weight loss was so sudden and so quick that I lost a ton of muscle mass, which is not easily regained, if it can be at all.
To this day, no one knows why it happened.
posted by Thorzdad at 6:25 AM on December 9, 2018 [1 favorite]
Without knowing what the weight loss is in relation to total body weight and whether the tests results were low/elevated within normal ranges it is quite difficult to say anything. The 20 lbs. is "only" 80-120 calories per day and the weight loss could be just a subtle and consistent change in you eating/activity levels. 20 lbs is worrisome if your BMI is (lets say) 20-25 but not as significant if it was 30 +/-. If your Dr is conscientious (as they appear to be in having ordered a number of tests) it would seem the next step is to frankly discuss your concern with them and ask for their input and direction.
posted by rmhsinc at 6:46 AM on December 9, 2018
posted by rmhsinc at 6:46 AM on December 9, 2018
It would be useful to know (can you message the mods?):
- what the trend looks like - are you still dropping weight?
- how has your BMI has shifted?
I lost about about 15 lbs over about a year, then stabilized at a new weight. I had some slow lifestyle/diet changes. I talked about this with my doc, they said that (summary) that my BMI was now average in terms of recommendations, my diet was better, and that my pre-weight loss BMI would have been slightly more of a concern.
posted by carter at 7:11 AM on December 9, 2018
- what the trend looks like - are you still dropping weight?
- how has your BMI has shifted?
I lost about about 15 lbs over about a year, then stabilized at a new weight. I had some slow lifestyle/diet changes. I talked about this with my doc, they said that (summary) that my BMI was now average in terms of recommendations, my diet was better, and that my pre-weight loss BMI would have been slightly more of a concern.
posted by carter at 7:11 AM on December 9, 2018
I’m not a doctor. I’m assuming your doctors course of action is based on experience and knowledge that you and I do not have. So I f I was in your position I would ask my doctor what is the clinical significance of an elevated ESR + unexplained weight loss. If they say nothing worth pursuing, I would get a second opinion. If your doc hems and haws then I would advocate for some type of imaging.
posted by pintapicasso at 7:53 AM on December 9, 2018 [1 favorite]
posted by pintapicasso at 7:53 AM on December 9, 2018 [1 favorite]
hurdy gurdy girl's answer is good, and I came in to recommend a thorough celiac screening, as a friend had the same issue and it was finally found to be celiac; she's much healthier now. Changing docs is a big pain, but I would at least push your doc to pursue this more, if you choose to stick with her.
posted by theora55 at 8:39 AM on December 9, 2018
posted by theora55 at 8:39 AM on December 9, 2018
Just in case this helps: I switched from Zoloft to Welbutrin and lost 30 pounds in a year. Did you change meds recently?
Still, everyone else is correct. Definitely get a second opinion.
posted by 4ster at 9:13 AM on December 9, 2018 [5 favorites]
Still, everyone else is correct. Definitely get a second opinion.
posted by 4ster at 9:13 AM on December 9, 2018 [5 favorites]
Definitely change doctors. But also, just to offer another anecdote that might be an antidote if you’re prone to anxiety, I had a friend who lost 15 lbs (though this was more than 10% of her weight) in a shorter timespan before she was 30. She freaked out, bc that’s terrifying? And it turned out when she switched jobs she also — not kidding — just stopped eating lunch at 5guys every day, and started walking more. I had something similar happen when I was younger for the same reasons. I would note any lifestyle changes you made, intentionally or unintentionally, if only to calm yourself while you search for a doctor who will take you seriously.
But for real, try to find a doctor that will take you seriously.
posted by schadenfrau at 9:15 AM on December 9, 2018 [2 favorites]
But for real, try to find a doctor that will take you seriously.
posted by schadenfrau at 9:15 AM on December 9, 2018 [2 favorites]
Are you having any other symptoms? I lost weight when my iron was low and it has come back (and then some) now that I got it up. I don't think low iron normally causes weight loss but it did in my case. Just something to consider.
posted by Amy93 at 10:37 AM on December 9, 2018
posted by Amy93 at 10:37 AM on December 9, 2018
Eighteen months is actually a fairly long time span, but the level of concern probably depends on your previous/current weight. I think the important thing here is that it is bothering you, and if you have the means to continue investigating it then you should do so. A new doctor is a good idea and when you are a new patient they tend to ask more questions because they want to get to know you.
Before you go to your new doctor, reviewing any and all life/lifestyle changes is a really good idea. Think about changes to sleep, daily routines, any time you have been sick in the past few years, any travel, new pets, medications, supplements , vitamins, drug use, etc.
posted by arachnidette at 12:21 PM on December 9, 2018 [1 favorite]
Before you go to your new doctor, reviewing any and all life/lifestyle changes is a really good idea. Think about changes to sleep, daily routines, any time you have been sick in the past few years, any travel, new pets, medications, supplements , vitamins, drug use, etc.
posted by arachnidette at 12:21 PM on December 9, 2018 [1 favorite]
« Older Another “can relationship be saved” question. I'm... | YouTube Transcriptions - Halp Newer »
This thread is closed to new comments.
posted by pazazygeek at 1:10 AM on December 9, 2018 [28 favorites]