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Archive for December, 2012

Vegetarian

This article is one of the few that I have ever seen discussing eating disorder recovery and vegetarian/vegan diets. I hope that someday I can be a vegetarian while maintaining health and without people questioning my intent.

http://edrecovery.com/vegetarianism-recovery-common-criticisms/

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Helping & Hurting

I hear the shock already: “Another post so soon?!” On rare occasions the hospital is overstaffed and they send people home on what is called “spontaneous vacation.” (Don’t worry we don’t get any extra vacation hours, they come out of the ones we have already accumulated, but not yet used) On even rarer occasions (usually after everyone else has had v-time multiple times) the staff remember that they are required to put the unit clerks into the spontaneous vacation rotation. Today was one of those rare occasions where I got to come home unexpectedly! Just for comparison most (if not all) of the other staff have had v-time in the past 2 months. My last v-time was almost a year ago. So I decided to use my free time to blog, make Christmas candy, and perhaps nap.

And onto the real point of this blog post:

For whatever reason people tend to find me easy to talk to. As someone who wants to work in medicine I suppose that is a good thing. And as a general rule I enjoy listening to people air their concerns, hopes, whatever.

But recently I have been concerned and frustrated with a couple friends and I don’t know if the fault is theirs or mine, or (most likely) a bit of both. These are both friends that I have met in eating disorder treatment at different times. Both are struggling with rather severe relapses. Actually, neither of them were ever recovered so it’s not so much a relapse as it is an increasing severity of symptoms. Regardless, I get frequent text messages from each one. 

Friend #1 lives in the same town as me. She texts me multiple times each day expressing her desire to [purge, restrict, exercise]. When I try to get her to talk about the issue or what else is going on (rule #1 of eating disorder treatment: it’s not about food/weight/shape/size) she just keeps going back to how fat she is. I try very hard to not give advice or tell her (or anyone else for that matter) what to do; I am trained in motivational interviewing and practice the principles constantly in one of my jobs. Occasionally I can elicit a commitment from her to practice some tiny bit of non-eating-disordered behavior. Those commitments are rare and she frequently backs out on them and then texts me about how she purged. From time to time she also sends me texts about check pain or a racing heart (she has had heart issues from the eating disorder) and when I ask she always admits that she had purged before it happened. My frustration with her comes for a few different reasons:

  1. I don’t know what she wants. She acts like she wants help but typically all I get from her is a playback of all the eating disorder behaviors she has done. And even though she spends lots of time in therapy and dietitian appointments she lies to them about what she’s doing and doesn’t follow through on what she says she will do. (okay, I will admit that I used to do this as well, but in my defense I never ever texted her every time I purged or complained about how my therapist was frustrated with me, and now instead of lying about it I was just honest and left therapy because clearly I didn’t want help at the time)
  2. Sometimes I’m afraid I feed her eating disorder. It’s a difficult balance. As a health professional I believe in a harm-reduction approach. This basically means that I consider any movement towards health (harm reduction) as positive even if the person never fully quits the behavior. As an example: I work with college students who drink a lot. Several go out 2-3 nights each week and have more than 10 drinks each night. They also happen to be underage. However, I don’t ask them to stop drinking because I know that will just alienate them. What I do work with them on is to drink in a safer way. If they make a goal to have 12 drinks a night instead of 15 I am all for it because although 12 drinks is still incredibly dangerous it is better than 15. And change can progress in small steps that way. So when my friend says that if she doesn’t purge then she will restrict my first instinct to to encourage that because I think purging is one of the most dangerous things she could be doing. Should I be encouraging restriction? Probably not, but I know for a fact that she will not both eat normally and not purge, so I consider restriction the safer of the two. It still makes me feel as though I might be doing something unethical though.
  3. It’s triggering to me. I put this one last because it really is the least important, but the more I get worn down my the continued texts the harder it is to not be triggered. When she tells me that she ate a small cheese quesadilla and now has to purge or she will get fat my mind immediately thinks back to everything I have eaten and not purged and I start to think about how fat I will be tomorrow. When she tells me how she “had” to go to the gym for x hours I think “clearly my moderate running/walking is leading to a life of obesity.” It’s exhausting and getting texts from her has started to make me hate myself more.

Last thing about Friend #1:  We used to get dinner together every week or two and it was nice. We were able to talk and it was a way for both of us to not have to struggle through a meal alone. But for the last 3 months she has made every last-minute excuse to not do dinner (I’m sick, I have too much to do for work tomorrow, my family is here). For a while I believed the excuses and then she texted me about how she was driving around mindlessly to avoid dinner with her roommate and I realized that most of those excuses were probably made up ways to avoid dinner with me. If you want to avoid dinner, fine, but at least be honest about it.

Friend #2 actually isn’t so much of a problem. I think it’s just that she is one more thing on top of the exhaustion from Friend #1. Friend #2 texts about once a week. She occasionally asks for support or advice, but she also makes a great effort to ask how I am and support me as needed. And when she does need support or advice and we come up with a plan together, she follows through. She really does want to fight the illness and although there are other things going on in her life that prevent her getting more intensive treatment, she definitely makes the best of the support she has. And writing this makes me realize that Friend #2 is not a problem at all, she just felt like it yesterday as she popped up between the texts of Friend #1.

So I know that Friend #1 is wearing me down. I clearly cannot help her as much as she needs and I’m not even sure she wants help. But I also don’t feel like I can tell her any of this because she will take it to heart. She will think that I am one more person who hates her and isn’t caring and leaves her in her time of need. And I am legitimately afraid that she would harm herself in the right circumstances.

What do I do?

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It seems to go faster every year. As a child I always heard adults saying that and equated it to being old. Does this mean I’m old now? Regardless, where am I in life right now?

I am not seeing anyone from my treatment team. E (therapist) suggested a break at the end of September. I had initially kept an appointment in late October to check in after that. I canceled it. I stopped seeing my dietitian and physician too. Honestly, I feel more settled than I have in a long time. I still have eating disorder behaviors, I still worry about weight and calories, but I no longer have this pull between doing what the eating disorder wants and what my team wanted to hear. I have a new normal and I no longer have the nagging in the back of my head that it isn’t right or the exhausting struggle to change.

I have completed all the work for my MPH although I’m still waiting to see if I passed my [pass/fail] practicum to officially graduate. I would be lying if I didn’t say that I still have a lot of anxiety about not passing and therefore not graduating.

Next semester I will be taking one class for several reasons:
1) The hospital (my primary job that supplies benefits) will pay for me to take up to 4 credits of a “work-related” class
2) There is a class next semester in the college of public health that I have been wanting to take.
3) My job at Student Health is officially classified as a student job, so to keep it I have to be taking at least one class.

I interviewed for the medical school at my current university just before Thanksgiving. I haven’t heard anything more. It is by far my first choice school but since this is my fourth time applying I’m not particularly optimistic. I have two interviews at osteopathic medical schools next week. In many ways osteopathic medicine seems to be a better fit for me. It has a greater focus on primary care, prevention, alternative medicine, and caring for the whole person. But I hate moving and the closest osteopathic schools are 2 and 3 hours from where I currently live 😦 Not to mention M absolutely refuses to move or go to one of the places (currently my 3rd choice). And allopathic (MD) school rejections have been starting to come in. It’s somewhat depressing. Additionally, osteopathic schools have a much faster turnaround time so in a month I will almost definitely have decisions from both of next week’s interviews.

On the home front. My house is a mess and it drives me nuts, but I’m completely overwhelmed about where to start with cleaning and decluttering. I have been shelling out some money for a new dog trainer. Zef had been having increasing behavior and aggression problems. It was getting to the point where I was avoiding walking him and dreaded just taking him outside briefly for the bathroom. And when I did take him on a longer walk or run my shoulder would hurt for a day or two after. This trainer was recommended to me by my academic advisor. The trainer has raised Australian shepherd for years. She comes to my house and works with Zef and I in our natural environment. She has come 3 times in about a month and a half and although progress is slow, there has been significant progress.

I’m sure there’s more, but that seems to be enough for now.

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