Short of breath
  Too tired
  The dwindles
  Weight loss
  Mom to be
  Very sociable
   Thanks To
 Mark W. Braun, MD

   Nutrition and Diagnosis-Related Care



Mr. James Robinson is a 72 year-old man who is brought by his daughter because of depression, difficulty swallowing and weight loss. Mr. Robinson says he has the 'dwindles.'
  • He has had Parkinson's disease for 7 years.
  • He was widowed 8 months ago.
  • He has been living with his daughter and son-in-law for the past 7 months, but they are increasingly having trouble caring for him.
  • He has lost 17 pounds since his wife's death.
  • He has recently been experiencing coughing and choking episodes when eating.
  • He describes himself as being tired all the time and feels he's a burden to his family.
  • He says he thinks it would be better for everyone if he "just wasn't around."

Physical exam: elderly man of moderate build in no apparent distress.

  • Mr. Robinson's height is 5' 10" and his weight is 156 pounds.
    • This means he has had a 10% drop in weight since his wife's death.
  • Vitals: Temp 98.6oF, BP 132/80, P 78/min and regular, R 18 without labor.
  • Chest clear, heart sounds normal with no murmurs.
  • Abdomen with no masses, bowel sounds normal
  • Neurological exam: stooped shoulders, pill rolling tremor, cogwheel rigidity.

So, is he losing weight because he's depressed and not eating or has trouble swallowing?

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