Best Medical Care Practices: Diverse Patients, Presentations, and Solutions

Gaudiani, Jennifer

Thursday, February 7, 2019: 10:30 AM-12:00 PM

Desert Salon 9-11 (JW Marriott Desert Springs Resort and Spa)

Background: In this workshop, Jennifer L. Gaudiani, MD, CEDS, FAED and Abby Brockman, RN will present cases of patients across treatment settings in order to highlight the diagnosis, treatment, and communication of medical complications that occur in those with eating disorders. Participants will gain greater familiarity with common (vital sign abnormalities, gastroparesis, constipation, bone density loss, lab abnormalities) and less common (psychogenic non-epileptic seizures, small intestinal bacterial overgrowth, outpatient tube feeding, Relative Energy Deficiency in Sports) medical problems our patients experience. Practical, immediately useful, and advocacy-oriented, this talk will highlight diverse patients and insist upon an approach that honors body diversity.

Objectives: By the end of this workshop, participants will:

Gain familiarity with common medical complications in those with eating disorders
Increase awareness of less measurable, more complicated presentations
Understand the importance of applying concepts of body diversity to patients across the spectrum of eating disorders

I. Introductions

a. Dr. Gaudiani: story and current outpatient clinic

b. Abby Brockman, RN (going for CEDS certification in 2019) who has some of the top experience in the country for nursing in those with eating disorders, from being a charge nurse at ACUTE to a charge nurse at ERC to working outpatient at the Gaudiani Clinic

II. Sharing of patient vignettes of more common medical problems, with a focus on size diversity and overall diversity of patients

a. “Cave person brain” and how the body reacts generally to starvation

b. Overall assessment tools when evaluating a patient medically: Vital signs from MD and RN perspectives (why they change, how to interpret them, assessment tools). This includes a discussion of symptoms of dizziness, passing out, athletic vs. starved heart, and true orthostatic changes. POTS will be discussed later. Ketones on breath. Urinalysis. Importance of getting the full story. Recognizing what would be expected to be found in a certain clinical situation and what is atypical

c. Hypoglycemia

d. Gastroparesis/constipation and triaging of common digestive ailments

e. Purging: key lab findings and how to interpret and manage

III. Sharing of patient vignettes of more complicated medical problems, with a focus on size diversity and overall diversity of patients

a. Periods, bones, testosterone, and the Relative Energy Deficiency in Sports (RED-S)

b. Irritable bowel syndrome and small intestinal bacterial overgrowth

c. POTS (Postural Orthostatic Tachycardia Syndrome)

d. Advanced concepts in outpatient nutritional rehabilitation: including the decision to initiate outpatient supplemental tube feeding and how to make that happen, reminder to avoid the underfeeding syndrome, and what one really needs to watch for regarding refeeding syndrome

e. Psychogenic non-epileptic seizures (PNES) in higher levels of care: classic nursing to make a difference

IV. Sharing of a patient case that then goes in different directions in order to demonstrate how we consider a level of care assessment (Outpatient? PHP? Residential? Hospital?) from a medical perspective

V. Practical use of a size diversity-honoring philosophy in the medical treatment of individuals with eating disorders

In this proposed three-hour workshop, Dr. Jennifer Gaudiani and Abby Brockman, RN, will provide a detailed, evidence-based, review of both common and more complicated medical complications, mostly pertaining to the outpatient setting, of individuals with eating disorders. This long workshop will give attendees the opportunity to learn some of the state-of-the art updates in the medical care of diverse patients, drawing from Dr. Gaudiani’s history in the field and Ms. Brockman’s decade of outstanding nursing and education that spans every level of care that can be occupied by someone with an eating disorder. Because the majority of doctors at best have little knowledge of eating disorders, and at worst represent an oppressor class that actually does harm to patients (by rendering those with “atypical” eating disorders invisible due to lack of emaciation, recommending weight loss strategies in one population of patients that would be considered disordered in another, or failing to recognize and communicate subtle and glaring physiological changes that occur as a result of caloric restriction, purging, or bingeing), many eating disorder clinicians must themselves become aware of these medical topics. By knowing the most current information, doctors, midlevels, nurses, therapists, dietitians, physical and occupational therapists, and more can best advocate for their clients and ensure that they are getting reasonable, sound care. An awareness of the medical complications of eating disorders also provides an opportunity to break through denial of disease and help motivate recovery. This talk goes beyond “101” level concepts to introduce some more complicated topics. It considers patient medical assessment tools like vital sign interpretation, edema evaluation, interpreting the urinalysis, and considering lab-work both normal and abnormal, as well as digestive dysregulation, and hypoglycemia. It also will review topics such as non-epileptic seizures, patient selection and practical employment of outpatient supplemental nasogastric tube feeding, athletes with inadequate energy intake, bone density loss, and less measurable problems such as POTS, IBS, and SIBO. This talk can be curtailed to be shorter and include less material, but we offer it as a longer workshop.

Primary Presenter:

Jennifer Gaudiani, MD, CEDS, FAED

Dr. Jennifer L. Gaudiani, MD, CEDS, FAED is the Founder and Medical Director of the Gaudiani Clinic, dedicated to the outpatient medical care of adolescents and adults with eating disorders. Dr. Gaudiani completed her undergraduate degree at Harvard College, her medical degree at Boston University School of Medicine, and her residency in internal medicine at Yale. Dr. Gaudiani was a leader at the ACUTE Center for Eating Disorders from 2008-2016. She has lectured and published extensively on the medical complications of eating disorders and sits on the editorial board of the IJED. Dr. Gaudiani's is the author of the book "Sick Enough: A Guide to the Medical Complications of Eating Disorders" (Routledge, Fall 2018)

Co-Presenter:

Abby Brockman, RN

Abby Brockman is the nurse for the Gaudiani Clinic, with over 10 years of eating disorder nursing experience. As one of the founding members of the ACUTE Center for Eating Disorders medical team, Abby helped create programming centered on exceptional clinical nursing with compassionate care, which are two of her professional core values. Following her time at ACUTE, Abby worked at Eating Recovery Center across several levels of care. Abby is passionate about patient education and strives to support and empower her patients to understand and care for their bodies. She loves integrating clinical and psychiatric care and watching the marked improvements that one can make with whole person medicine.

See more of: Workshops

<< Previous Proposal | Next Proposal >>