Anorexia and Laxative Abuse — Potentially Deadly

She was twitching.  A sweet little girl only 23 years old with make-up and a hair-do that probably cost her more than one week’s worth of my salary.

I once saw a professional opera production of Donizetti’s “Daughter of the Regiment.” The leading lady — whose hair I remember because she was a redhead like me — had a less elaborate hairdo.  But unlike the diva of the opera, this young lady twitched.  My God, could this girl twitch.

The therapist at the agency who called for my assistance in this unusual case went out of her way to tell me that this girl was not a substance abuser.  This adorable Dresden Doll of a woman did not abuse substances and she was twitching faster and faster as she and a social worker aide sat in my office.  And she was getting more nervous.  I always try to relax people and to make them feel at home, but this girl was a bundle of nerves.

The best news was that she had not seen another psychiatrist or even a general doctor.  A “normal” medico would have zonked this little doll with drugs to keep her zombied-out – the standard treatment for nervousness in most health facilities.  Ugggh!

This poor, suffering patient was getting exasperated with me.  She wanted to talk about her nerves and I wanted to talk about her health.  I was focused on her body — her tiny body.  I was looking for a medical history consistent with seizures.  I suspected that her electrolytes –- the minerals in her blood — were all pumped out and dried up.  This is not unusual and could easily account for her twitches.

I do most of my business within a reasonable radius of the show-biz community.  Once I consulted within view of the “Hollywood” sign.  In that clinic, both the patients and the staff were all taking some kind of stimulant –- mainly to keep from gaining weight or to lose weight.  Their speed abuse –- everything from caffeine to the prescription stuff in the sample cabinet — had the whole office jumpy.

I speculated my Dresden Doll could have an eating disorder.  Looking at that figure, I was sure she did — but that has to be pretty far gone to make you twitch like she twitched.

She finally admitted she had been fasting, in the expectation of a “casting call.” Unfortunately, for her, she thought fasting included all food and water. She would not tell me how many days she had abstained.  I ordered someone to bring water.  She drank it.  Better but nowhere near normal.  One of the male staff therapists (who pumped iron for his casting calls) offered his Gatorade – which athletes use to replenish electrolytes.  A little sugary, but we diluted it.  She started calming down.

I asked more questions, and finally got around to asking about laxatives.  I knew I was on the money, because she was really angry at me now.  “I came here for Xanax for my anxiety and you made me talk about — well, my own shit.”  Bingo — She was a laxative abuser.

I have treated laxative abusers before, and they can be as hard to get off of as heroin (or Xanax).  It must be done slowly.  There is also a psychological component, of course.  If someone expects to evacuate five times a day, they go into a panic when that frequency drops.  They think they will never be able to go again.  And of course, the main reason for taking laxatives is to lose weight and keep it off, so they feel condemned to gain weight.  This is actually enough to drive someone suicidal if you aren’t careful.

So you get the picture — this is tough stuff to treat.  But not just because of the psychological part. The main worry is that the body is depleted of the vitamins and minerals so completely that the body can’t work to keep the vital organs together, to keep the heart beating.  I took her pulse.  The electronic machines we have today are useful and accurate for giving a number of beats, but sometimes I need some information that I can only get by taking matters into my own hands – literally.

I took her pulse with my fingers.  It was irregular.  It felt a little more regular as I sat there telling her to drink more yummy stuff.  Someone on the staff actually brought her some kind of a wild organic concoction which seemed pretty foul to me but she actually said she wanted it, so I let her have it.

My Dresden Doll with the Daughter of the Regiment hairdo did not go to an eating disorder clinic, although she seemed to have anorexia, among other things.  I sent her to an emergency room, and I phoned ahead to tell them she was coming.  I knew what they would and wouldn’t do, and I made sure they knew to check her electrolytes.  My pulse-taking revealed she had some problems with the body’s electrical conduction system that made her heart beat.  Anorectics often have heart attacks for this very reason.

My patient was low on potassium, as well as dehydrated.  They gave her some fluid that was rich in lovely electrolytes and she stopped being so very nervous.

She declined admission to their eating disorders program.  However, she realized that I had solved her problems – anxiety and twitches – and probably saved her life.  Before I left that clinic a couple of weeks later, she came back and thanked me.  That’s the kind of reward a doctor truly values.

Anorexia nervosa has a death rate of about 10%.  Cardiac arrhythmia usually has something to do with the cause.  Symptoms do not usually show up until about three weeks prior to death.  I could have saved her life.  She actually figured that out, listened to me some, and we got a nutritionist involved to help her.

The last time I saw her, my Doll said she felt a great deal better and claimed that she followed my recommended slow cut back on laxatives. Her weight went up a bit, but that didn’t cause her the type of trauma it could have a month or two earlier.  We talked about other issues, and she agreed that life was starting to be good.

The concept of “recovering” works here.  The only part of this story I REALLY had trouble with was the crazy Hollywood organic nutritionist, who had apparently once been anorectic herself.  I never figured her out, never trusted her, and only talked to her once.  However, the patient loved her, so we were stuck.  If people listened to me , life would be different.

The Dresden Doll actually got some small acting parts.  And at least she was eating something, although it did sound like more foul organic stuff.

Here is a surprisingly good article on how you can get “hooked” on over the counter drugs in general and laxatives in particular.

The people at the national eating disorders place have a good handout about laxative abuse in eating disorder patients.

Here is a good general guide.  If you know of someone abusing laxatives or emetics (like syrup of ipecac, which you give to someone who has swallowed poison to make them vomit) definitely have a visit with a doctor.

Even though these are sold over the counter without a prescription, varying the doses can be dangerous in general and taking too many laxatives, in particular, can be a life threatening situation.  Yes, they have warning labels but few people read them. Fewer people still make intelligent decisions about them.  Some products don’t work with the “one-size-fits-all” directions on the package and must be dosed according to a person’s weight –- increases for large people and decreases for small people.

I have seen LOTS of people get into trouble by playing with their own doses of drugs, whether the drugs in question are prescription or over the counter.  Supposedly safe and natural supplements -– even vitamins -– can have problems too.

Ask a doctor who knows what they are doing.  Please.  The world of medications is full of surprises.