Denver IAEDP Chapter Winter Gala
ACUTE Center for Eating Disorders at Denver Health is the nation's only specialized medical stabilization center providing care for the most medically compromised eating disorder patients. For more information about ACUTE or a free medical assessment, call 877 ACUTE 4U or visit ACUTE online.
2014 ACUTE Symposium: Improving Medical Care for Eating Disorders
February 20 & 21, 2014
The first ever symposium dedicated solely to the medical care and complications of eating disorders will be hosted by ACUTE in Denver, CO next year.
The ACUTE symposium will provide treatment providers nationwide a rare opportunity to learn current best practices in medical care from the industry's leading experts.
The two day symposium will include introductory sessions for those with limited medical knowledge as well as intermediate and advanced education for physicians and other medical providers.
In order to provide an intimate learning experience registration will be limited.
Symposium announcement, detailed course descriptions, and registration information will be sent early November. Please register early!
For more information, please feel free to contact Rachael.Harriman@dhha.org
The ACUTE Difference
ACUTE's approach to the use of feeding tubes in the severely low weight, medically compromised patient may surprise you.
ACUTE Center for Eating Disorders at Denver Health is known for its care of the most medically compromised and severely low weight patients with anorexia nervosa. What many people don't know is that ACUTE does not use feeding tubes as part of the early nutritional rehabilitation plan. Rather, we support and encourage each patient to begin a balanced diet of oral nutrition.
Each patient works directly with their dietitian to create their own meal plan based on their current dietary needs, and personal preferences. Calorie levels start at a safe level and progress slowly in order to avoid the common discomforts and complications of refeeding syndrome. This allows us to keep each patient medically safe, while allowing each individual time to adjust and process emotionally what it means to begin their recovery and let their body begin to heal.
To help with their nutritional rehabilitation each patient receives:
- Individualized meal planning with a specialized dietitian
- Supported, private meal time with ACUTE staff
- The option, rather than punishment, to utilize supplements when feeling overwhelmed
- Accommodation of dietary intolerances and allergies
- Daily individual therapy with ACUTE's psychologist
As a highly specialized medical unit, ACUTE's team has the ability to deliver nutrition through the use of naso-gastric feeding tubes, surgically placed PEG or PEJ tubes and other alternative options when deemed medically necessary. However, even with ACUTE's severe patient population, this only becomes necessary in less than 10% of patients.
ACUTE Medical Minute
Did you know? Patients with extreme weight loss-which may or may not result in "underweight" almost universally develop a condition called "gastroparesis," or loss of the usual peristalsis (smooth muscle contractions) of the stomach. In healthy digestion, the stomach finishes digesting a meal and smooth muscle contractions empty the gastric contents into the small intestine for further processing, leaving the stomach empty and promoting a sense of hunger before the next meal is due. When a great deal of body weight is lost, this normal emptying process is delayed, sometimes severely, and food may remain in the stomach for up to five times longer than normal.
Gastroparesis in this clinical setting is so common as to make a nuclear medicine emptying study (to diagnose it formally) rarely necessary ... a patient with significant weight loss who notes symptoms of early satiety (fullness), bloating, nausea, and lack of hunger before the next meal almost certainly has gastroparesis. We understand that gastroparesis of weight loss comes from metabolic slowing...I frame it to patients as:
"Your body is so starved, it doesn't want to waste a single calorie on smooth muscle contraction!"
This has a significant impact on patients with eating disorders, because the symptoms of gastroparesis cause a physical impediment to food consumption that only exacerbates the existing emotional resistance. In fact, patients may identify that when they practice mindfulness and "listen to their body" it gives them the message that food hurts, and thus they avoid eating enough food or certain types of foods.
Clinican awareness of gastroparesis
can really help establish a good therapeutic relationship when it comes to the medical complications of eating disorders. Every patient should be asked about these symptoms. If they have it, an explanation of the cause should be shared with the patient, and a validation that their symptoms aren't part of the distortions of an eating disorder...they are organic and have a medical cause.
Dietary teaching should include recommendations for more frequent, calorie dense, and smaller meals, avoidance of fiber which worsens the symptoms, and a reminder that liquids and semi-solids generally pass normally through into the small intestine and can help reduce symptoms.
Gastroparesis should resolve with good nutrition and weight restoration. If needed, prescription medication may be offered as long as close medical follow-up is available. We use primarily metoclopramide in very small doses, 2.5 mg fully 30 minutes before breakfast, lunch, dinner, and bedtime. This causes normalization of gastric emptying without any effect on bowel function. Any muscle twitching, especially of the lips or tongue, should cause immediate cessation of metoclopramide, and an EKG should be checked at baseline and within the first week of metoclopramide administration, watching for QTC changes. Metoclopramide should be stopped as well when a patient has entered a normal weight range and is a "bridge" to weight restoration.
Click here for more information about ACUTE's specialized medical stabilization program.
ACUTE Information Close to Home
ACUTE's Program Manager, Rachael Harriman, handles all admissions and outreach events for ACUTE. This fall, she will be visiting professionals and treatment programs across the country to share additional information about the programs available at ACUTE. If you would like to schedule a visit, or are interested in having Drs. Mehler or Gaudiani speak at an upcoming event, email Rachael
We look forward to meeting you!
|Philip S. Mehler, MD, FAED, FACP, CEDS|
Led by Dr. Philip Mehler and Dr. Jennifer Gaudiani, patients are offered the very best in medical stabilization and treatment, a compassionate and highly experienced nursing staff, individual psychotherapy, physical therapy, and thorough discharge planning to help them begin recovering. The ACUTE Center is tailored to help both males and females who cannot seek care in a traditional inpatient or residential treatment setting due to the severity of their weight loss or other medical complications. ACUTE contracts with most insurance companies and uses the patient's medical
insurance benefit for stabilization care.
|Jennifer L. Gaudiani, MD, CEDS|
Who to refer to ACUTE for stabilization:
- Any patient weighing less than 70% of his/her ideal body weight
- Serious medical complications (electrolyte disorders, fluid problems, organ failure, previous bouts of refeeding syndrome)
- Need to "detox" from severe purging, laxative or diuretic abuse