To Your Good Health: Elderly man weighs 84 pounds decades after his stomach removal

Is 18 years a record for living without a stomach? A family member had stomach cancer when he was 70 and had his stomach removed. He consulted with a dietician and has been able to eat small but frequent meals. He can also take enzymes, vitamins and other things, but slowly he has lost weight. Now at 88, he is down to 84 pounds, and his muscles are also affected. He used to play racquetball regularly, but this came to an end during COVID and wasn’t picked back up after the pandemic. He can no longer walk without assistance. They are putting a feeding tube into his small intestine to supplement what he usually eats. Are you familiar with this type of thing? What else can be done, or is this the end? Will he starve to death?

I have seen many patients with stomach cancer and have never seen this degree of weight loss, but weight loss is very common after removing the stomach. This degree of weight loss is very disturbing and usually results in a worse outcome, so effective treatment is overdue.

A feeding tube, which isn’t often the appropriate treatment for weight loss, seems to be an important short-term treatment. I assume that he has had extensive evaluations for the recurrence of diseases, including CT scans.

You mention that he has been getting vitamins; B12 and vitamin D levels are often profoundly low after gastrectomy, or removal of the stomach, so these should be checked, even if he has been on replacements. If no other cause is found, it might be worth a try to use an appetite stimulant.

In addition, I would formally measure his total calorie input in a day to see whether the problem really is that he isn’t getting enough calories. I would be worried that he isn’t absorbing all of them.

There is no reason for him to starve to death. In the very worst case, nutrition can be given intravenously while they figure out why he is losing so much weight.

I am an 84-year-old male in amazingly good health and have great physical abilities, but after running about three miles, I noticed some minor chest discomfort. After a calcium score test and stress test, my doctor wanted to place stents in my coronary arteries. I read a National Institute of Health study from 2020 regarding stent outcomes versus medication and lifestyle changes, and it showed no difference in the outcomes. So, I decided not to do the stents. I no longer do any distance running, but I do weight training and a stationary bike exercise for 10 minutes without any chest issues. I now take statin drugs, blood pressure medicines and baby aspirin. Are you familiar with this study, and am I doing a reasonable thing by not having the stents inserted?

Whether stents are beneficial in people with stable coronary artery disease remains somewhat controversial. Although stents in combination with a healthy diet, exercise and medication may improve symptoms better than lifestyle changes and medication alone, there are no data to show an improvement in lifespan or in preventing heart attacks.

Your cardiologist wanted to reduce your symptoms, but if you aren’t having any now, then stenting isn’t indicated. If you had to reduce your running because of chest discomfort, then stenting might possibly allow you to do more exercise without having these symptoms.