Author: Erin Hammer, MD
Co Author #1: Kathleen Carr, MD
Editor: Christian Fulmer, DO
An 18 year-old female collegiate lightweight rower with a history of generalized anxiety disorder and depression presented to clinic at the behest of her athletic trainer with 6 months of worsening nausea, vomiting and weight loss. Her symptoms began one year earlier with diarrhea associated with stressful swim competitions. Her family physician diagnosed her with irritable bowel syndrome, but her symptoms eventually progressed to early satiety with vomiting after most meals. Within six months of starting college, she had lost over 30 pounds. She denied dysphagia, but developed nausea minutes after finishing a meal. She endorsed fatigue, cold intolerance and constipation. She specifically denied intentional restricting or purging. Her menses usually occurred every other month, but she had more recently been amenorrheic for 3 months. She was a vegetarian since high school and had recently eliminated lactose from her diet with no improvement in her symptoms.
In addition to her mental health history, she had a history of thoracic outlet syndrome. She had never had surgery. A team physician had prescribed citalopram and as needed alprazolam for depression and anxiety 3 months earlier. Her father had anxiety. She reported that her mother has an undiagnosed mood disorder and her sister was obsessed with her weight, but had not been diagnosed with an eating disorder. She endorsed a stressful relationship with her parents and describes her mother as “controlling”.
Blood Pressure 105/75, Heart Rate 48, Respiratory Rate 16, Oxygen saturation 98%
Height: 1.753 m (5’9”)
Weight: 104.2 pounds
BMI: 15.4 kg/m2
General: Alert, oriented
HEENT: Moist mucous membranes, normal dentition
Chest: Clear to auscultation
Cardiovascular: Bradycardia, normal rhythm with no murmurs, rubs or gallops
Abdomen: Scaphoid abdomen, bowel sounds active, no tenderness or masses
Extremities: No edema. Lanugo noted on bilateral forearms.
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