Posts Tagged ‘treatment’

I know I was supposed to/going to stay at partial until I was at target this time round, but that really didn’t work out. Once again I left before anyone really wanted me to, but I had a different reason this time.

Because it’s a large hospital the staff doctors rotate through different services. The assignments are made by the head of each department. The eating disorder program is under the psych department. My unit (med-psych) is under the psych department. Until now I haven’t had to deal with staff doctors from my unit being on partial; I’ve only had to worry about all the coworkers I run into while I’m at partial (just two floors above, in the same part of the hospital). But on July 1 a new staff doctor came on eating disorder rotation….and she has worked 4-5 months of the past year on med-psych. Some staff doctors would handle this transition well, but I was concerned about this particular doctor. And unfortunately my concerns came true and it was not a good switch from coworker to patient…in fact it wasn’t really a switch, I was still a coworker. I didn’t get anything out of it and I was embarrassed to be there.

So I left. And like every other time I’ve left before I reach target I dropped weight immediately. I’m not entirely sure how it comes off so quickly because I swear I’m not attempting to lose weight I’m just not attempting to gain it anymore.

So I’m back in the cycle. I lost 3.5% of my bone density in the last 1 1/2 years. I know I’m not helping myself with this and I’m not sure I care anymore. I want to quit going to appointments. I want to quit seeing doctors. I’m not sure they can help me anyway.

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…in partial that is.

It was a hard day. Hard because I was back. There are a couple people there that have been through the program but for them it’s been years and years. I’m the only recent readmission.

Hard because I was in the same hospital where I go to school and work every day.

Hard because I don’t know if I care about the why of it anymore. I kind of feel like that is beating a dead horse and has really become irrelevant. All I want to know is the how. How do I get out of this? How do I keep from falling back in?

And I’ll admit it, there’s still hesitation. If I could get better without gaining the weight I would do it. If I could gain the weight and never have to think about it again I could live with that. But I know it’s going to be a never ending struggle. I pray that it isn’t my solution for everything (med school too hard? lose weight. Difficulties at work? Lose weight.) although I know that for a long time it will be at the front of my mind.

But I’m so scared. I’m scared of getting fat. I’m scared that my fellow public health students will think I’m huge when I get back. I’m scared that I’ll be the fattest person in my med school class.

But I’m not brave enough to talk about these yet. Instead I sat all day in group, on the verge of tears.

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I’ve mostly stopped fighting it now. After last week when I worked so hard at eating and I still lost weight. And this week where I can’t make myself eat.

And last night when I nearly started crying in class. We were working in groups on a needs assessment and intervention planning. The assigned topic: healthy eating. It started out with a couple people going on a rant about how muffins are really just cake and people fool themselves into thinking muffins are healthy. These are the people I see in class every single day as I eat my (extra-large) muffin and drink a frappe. Can you say calories and sugar? An idea for the needs assessment was to give people a list of foods and have them make lists of the healthy/unhealthy ones. (The ED treatment mantra is “there are no bad foods.”) Then it went on to designing an intervention. They chose to focus on college students with a meal plan. One suggestion was to place calorie counts next to “unhealthy” items along with something saying how many minutes/hours/miles you would have to exercise to burn it off. I was screaming inside and it was nearly 15 minutes later when someone was like “maybe we shouldn’t do that with concern for eating disorders on college campuses.”

I went home and sobbed. Sobbed about all the damn healthy eating/obesity/physical exercise interventions I’ve had to design. Sobbed about how I couldn’t even finish my muffin and coffee. Sobbed about how full and fat I felt when I only had 600 calories yesterday. Sobbed about going back to partial.

And yet it was a bit of a relief. Knowing I probably would go back to partial, but also knowing that would give me a respite from all the health behavior lectures I struggle through every week.

I talked to S—-, the director of partial, yesterday. She did help me realize that it would be okay. I could still make school and work fit in, though probably not on the schedule I have been doing.

Random funny story about S–. She is one of my favorite people and last time I was in partial I (only half-jokingly) said “I want to grow up to be just like you” Her response was “Honey, I don’t think you’ll ever be as tall as me.” And she was very serious. Haha.

Anyway, I’m looking forward to maybe getting some more help. That I’ll be able to take on food in a more supportive environment. And that I’ll get a short break from obesity iterventions.

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Once again I stand at the edge of it.

I was told last week that I had to gain x lbs this week or I would be going back to partial. It was so hard, but I ate. I ate because I knew I had to and then I freaked out about gaining weight and eating too much. I’m afraid it didn’t make much of a difference though because for the last three weeks I have been stuck at precisely the same weight regardless of what I ate.

The only reason I’m resisting partial is my job. Working on a psych unit. But it’s not necessarily that, I don’t want to have to tell my boss or coworkers why I need time off. And from time to time I work (as a colleague) with some of the people who work in partial. I don’t want to be in the large percentage of eating disorder patients who relapse. I want to present the image of being strong and capable of everything I take on.

Apparently I am not. And that makes me feel like a failure.

I see E— at 1 today. Crunch time has arrived.

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I suspected it would happen eventually. And it did. Two weeks ago.

I got pulled to the eating disorder unit.

I don’t even have that much to say about it. But apparently it affected me.

They were all so thin. Much thinner than I am (or so I tell myself). A couple had had seizures from electrolyte imbalances. Many were committed.

Part of my job was “Eating Disorder Observation.” All eating disorder patients are automatically required to be on “standard” observation…which means that they must spend all of their waking time in the unit dayroom (or in groups when those are occurring).  After reaching a certain behavior level they may be considered for a different observation (meals + 2 hours or meals + 1 hour). A nursing assistant is required to be in the dayroom with them at all times–to “redirect.” Basically make sure they sit down at all times (and tell them to sit if they attempt to stand, walk, stretch, etc), don’t talk about food or weight, don’t jiggle their legs, sit on prescribed cushions/recliners if they have them.

I got to be that NA for a while. Oh joy. How can I stop them from jiggling their legs when I never stop it myself? How can I force them to sit down if I can’t do it myself?

But first let me say that on my unit, although it is a psych unit we also have very medically sick people, and I spend most of my shift in constant motion. So being pulled after 4 hours of that was a cataclysmic change. I sat on a 1:1 and read my book for a while, then sat on observation. And after 10 minutes or so I found myself reading the bulletin boards, wandering the halls within eyesight of the dayroom, looking at the whiteboard, re-reading all the bulletin boards, and generally just standing/pacing the whole time. damn. So I sat back down. And 5 minutes later was back at it. Even after all the patients had gone to bed I stood while I talked with the other NAs. One even told me to “sit down, relax a bit!” Was it that obvious?

I didn’t think it affected me. And while I was working it didn’t really sink it because my head was in “work” mode. I work from my doctor brain.

And then I left work. And immediately I was analyzing all the foods in my fridge. Why do I enjoy eating greek yogurt? It has so much fat and protein. And the peanut butter and nutella in my cupboard….It doesn’t matter that I don’t touch the jars, just the fact that I have such foods is a disgrace.

And it gave me a chance to tell myself that I don’t really have a problem. I’m not thin enough to be committed. It doesn’t matter that I’ve lost x lbs in the past year. It doesn’t matter that I have an actual-active-diagnosis of anorexia. My blood labs are always fine, I won’t have a seizure. Look at me, in grad school and working a full-time job, if I were really sick I wouldn’t be able to do that.

And it made me sad. I’m so miserable. I want help but I’m too afraid to ask because I’m afraid that I’m not “sick enough” to need it and I will be rejected. And now that I work in the psych department it makes the patient/provider roles all confusing. I’ve managed them very well up until now, because in the beginning I convinced most of them that I was doing better. But yesterday I saw K—- in the cafeteria during lunch time. I was doing schoolwork and not eating. She usually will talk to me a bit, but today was a stiff hello and a sad look. She can see it–the weight loss and skipping lunch.

I’m afraid that everyone will know that I have an eating disorder. I’m afraid my competency at work will be questioned.

I’m afraid someone will force me into treatment.

I’m afraid that no one will convince me to get treatment.

I am afraid of living like this forever.

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I know the typical treatment program’s view on triggering language, behavior etc. I also understand why many of them have those rules.

My most recent treatment program had none of that. We were able (in some cases encouraged) to talk about specific behaviors we had engaged in and in fact some of the therapists would purposely used triggering language during groups. Why? Because that’s how the real world works. Outside the walls of treatment people talk all the time about food and fat and calories. The entire population doesn’t walk around thinking “I wonder if she has an eating disorder? Perhaps I should say this in a different manner or avoid it altogether.”

And you know what? I liked it. A lot.

I have had my times when things have “triggered” me–sitting in a psych lecture where we spent an hour talking about obesity and how to avoid it and then some time spent talking about eating disorders with triggering pictures and whatnot. It was an incredible difficult lecture, in a class of 1000 people, so I’m sure I wasn’t the only one who struggled with it. But would it have been okay for me to talk to the lecturer and tell her that? I don’t really know. She was just doing her typical teaching thing, 99% of the students probably didn’t have a problem with it, and how often in life am I going to get into similar situations where I don’t have the right to bring such subject matter up?

No matter how careful a person is and how much she tries to avoid triggers, they will happen. And if I am restructuring my life to avoid ED triggers, then I am not enjoying full freedom from the eating disorder.

If there is a time and place to learn to face and deal with triggering language, therapy is it. Surrounded by supportive people, with a chance to express and deal with emotions, one doesn’t have to just stuff it down. They are in a unique position to face the underlying issues about why that language triggers them. There are other ED sufferers that understand the difficulty in hearing it and there are professionals trained to help them work through it. I think that a treatment center that is willing to face the realities of this is very intelligent.

And now that I’m out of intensive treatment, I find that having to censor my thoughts is very difficult. It’s cumbersome and it distracts me from what I am thinking and feeling about the real issues I have. There’s always that voice in my head going “Can I say this? Should I say this? How much of this should/can I say?” and if that inner dialogue goes on long enough it becomes “Well, I don’t really know where the safe zone starts or stops, so I guess I won’t say anything.” And that is where a ban on triggering language moves from being a safeguard to being a liability.

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I have returned. My stint in treatment is over, now it’s up to me. I am scared. I’m scared because I still struggle to believe that my ultra-low calorie consumption was a problem because I didn’t lose very much weight. I’m scared because there are many times that I can’t bring myself to eat a full meal, but I’m scared of eating at any other time because I equate that with getting fat. I am scared because I still so terribly want to return to my old habits.

Now I am back to school. I have so much work to do to make up for missing two weeks. Papers to write, chapters to read, administrative people to talk to regarding my absence. It’s all a bit overwhelming right now. Not to mention my apartment is a disaster from finals week followed by five weeks of hopping in briefly and dropping a few things off while picking other things up.

I just need to keep myself focused. I’m trying to choose my top 2-3 actions to get done and then limiting my work to that. I have a tendency to make very long lists that can be overwhelming to the point where I don’t want to do anything. However I must remember that I can only do one thing at a time, so as long as there is at least one item on my list, I’m covered.

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