I can’t decide if I am seeing more truly starving patients since I started focusing on nutrition, or if I’m just more sensitive to it. All 3 of these patients have a body mass index (BMI) of less than 17. The first patient completely healed a stage 4 pressure ulcer with 2 packets of Juven daily, even though he lost more weight due to a terminal illness.

The patient in the second photo has a Body mass index (BMI) of less than 13. I will grant you he has muscle loss from a spinal cord injury, but is it any wonder that he’s covered with pressure ulcers? I can almost encircle his upper arm with my small hand.

I’m struggling to feed patients #2 and #3 due to mysterious gastric issues. I am trying to convince them that it’s time for a feeding tube if that’s what it takes to correct their nutritional status. Both patients are focused on what I’m going to put ON their wounds and I’m trying to convince them that it hardly matters when they are starving. Everything depends on what we put IN them. And it seems I’m the first doctor who has told them that.