Dr Eric Daiter has served Monmouth and Middlesex Counties of New Jersey as an infertility expert for the past 20 years. Dr. Daiter is happy to offer second opinions (at the office or over the telephone) or new patient appointments. It is easy, just call us at 908 226 0250 to set up an appointment (leave a message with your name and number if we are unable to get to the phone and someone will call you back).
Availability
"I always try to be available for my patients since I do understand the pain and frustration associated with fertility problems or endometriosis."
Cost
"I understand that the economy is very tough and insurance companies do not cover a lot of the services that might help you. I always try to minimize your out of pocket cost while encouraging the most successful and effective treatments available."
Anorexia Nervosa
Anorexia nervosa is characterized by a morbid fear of obesity.
The reason for this disorder is not clear but many believe it
originates because of an inability to cope with sexuality and
represents the woman's desire to return to a prepubertal state.
The mortality rate with anorexia nervosa is high (5-15%) so a
heightened index of suspicion is warranted. These women are typically
success, appearance and achievement oriented with a tendency to
be overachievers. The diagnosis is based on standard criteria,
including
* refusal to maintain a normal body weight, with loss
of 25% of original body weight or a weight of 15% below normal
for age and height
* special attitudes regarding food, including a distorted
body image with the feeling of personal obesity
* one of a variety of signs or symptoms, including
lanugo hair, bradycardia, overactivity, episodes of bulimia, or
vomiting
* amenorrhea
* no known medical or psychiatric disorder leading
to the weight loss
In addition to the historical and physical findings, laboratory
evaluation may reveal
* normal TSH and free T4 but low T3 and high reverse
T3, simulating the "euthyroid sick state." This may
be a nonspecific response to starvation in which energy is conserved
by preferentially converting T4 to reversed T3 (which is less
bioactive)
* low FSH and low LH concentrations, resulting in hypogonadotropic
hypogonadism
* increased plasma cortisol level (which can be used
to distinguish the lab findings of anorexia from panhypopituitarism)
Extensive hormonal evaluation is not clinically necessary when
the diagnosis is clear. Treatment can be difficult but often a
careful frank discussion revealing the relationship between the
ovulatory dysfunction and anorexia is all that is required. Treatment
is more difficult in the presence of denial, due to noncompliance,
and referral to an appropriate counselor may be required.
