It's Sat morning here so I'm responding to comments that go back a few pages.
My own interpretation of that remark in context was not that he was saying it would medicalize her as opposed to psychologizing her--in other words, I don't think he was necessarily suggesting the kind of stimulus challenge based on the GET theory. It seemed like he was mainly saying that it would medicalize her in the sense that it might leave her permanently unable to digest normally because various muscles would atrophy permanently. I could be wrong, but that's how I took it.
I am pretty certain that 'medicalise' in this context means to give credence to biomedical explanations and management approaches for an illness. That is the only UK medical usage I am aware of in this context.
Absolutely "medicalise" is only ever used in the way Jo describes. To validate and re-inforce that there's a medical (ie biological) problem when (
we are convinced) there isn't one. The thinking being that this will be a positive feedback loop that perpetuates the patient's delusion/functional disorder. I have no doubt this can happen, but it's vastly overplayed to include nearly everything that medicine doesn't yet understand the biology of. Starting to change only very recently, non-cardiac chest pain (esp in women) fitted into this category, "helped" by the inevitable and quite understandable anxiety you would observe with the presentation.
A related concept is the risk of "becoming institutionalised" / "institutionalisation".
I am left wondering what happened to PEG feeding?
We are given reasons for not using TPN IV lines - infection.
I am not aware of an equivalent risk of septicaemia for PEG.
You do see infections around the stoma very occasionally, but it's pretty rare.
I can't recall a case of sepsis. Wait — I do recall one PEG replacement that went wrong resulting in peritonitis and death.
But more often it's excoriated skin if there's a leak of gastric fluid around the PEG. Sometimes the skin breakdown could open the stoma wider and then the retention balloon can't hold the seal and everything get's worse. The surgeons would then do something like remove the device and allow the stoma to heal and then re-position. I can only think of one example from years ago but not the details. Alternative feeding pathway would then be temporary NGT/NJT or possibly direct jejunostomy. I can't recall if temporary TPN might have been used in this sort of situation, but I'm confident my gastro and surgical colleagues would have no issue moving to that if required.
Just as a side note: in intractable intestinal failure from some rare early life causes, TPN is maintained until central venous access is exhausted. And I've seen our surgeons be very creative in the late stages. This means that if the patient then becomes a candidate for en-bloc intestinal/liver/pancreas transplant there is very little vascular access. I make this point to highlight the differences in approach, where the "never give up, never surrender" model contrasts so starkly with what we're seeing in the inquest. Many of these childhood conditions would also be characterised as
complex. I should also note that the psychological effects on child and family are hugely consequential - it's just that no-one thinks that's what started it all off.
A valid hypothesis, hard to test, however. Worth noting that the case of the SARS-1 survivors in Toronto all went through very extensive rehabilitation regimens and all of them are still highly disabled.
Yeah the idea that GET caused more severe presentations is a good one. I hadn't thought of this. I don't think it's a requirement though, eg I didn't see reference to Physics Girl doing GET before she became severe. However there's possibly an element of self-GETing that may even be a bigger factor. Going to the gym as a general activity that "most" people did is new phenomenon, starting in the 80s and picking up through the 90s to be very common today.
Proving it? As commented above I doubt we could or should do trials. But I suspect this answer will become very clear once metabolic, muscle, vascular mechanisms are elucidated: eg. Hanson, Wüst.
