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j9k22

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Reply with quote  #1 
A year-and-a-half ago my pediatrician recommended an outpatient program. I reached out to the school guidance counselor and she recommended this outpatient program as well. I got in touch with them as they take our insurance when they didn't 18 months ago. It seems to be highly regarded but I'm not sure if it's a family-based treatment program. I did ask and they said at the Albany site 2 hours away there was a maudsley therapist but she had a waiting list until April. I'm scared that this might not be the right route to take. It seems like a good plan because it's an outpatient program and my daughter can still go to school during the day. As long as she doesn't require inpatient treatment after they evaluate her. The only thing is I realize I'm going to have to end her dance class program. We paid for an unlimited number of dance classes which cost quite the pretty penny. There's four payments in the year. The 4th payment is due next week. There's also a recital that I've already paid for and bought six costumes costing me somewhere around 500 or so dollars. Kind of makes me sick to my stomach that I'm going to have to lose all that money. I know I sound crazy right now to some of you but I hope you can understand how hard this is. The program is http://hpalivewell.com. it's based in Albany and Poughkeepsie New York. Has anyone heard of it? Maybe I should look into one of those five day or week long intensive programs too.
martican

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Reply with quote  #2 
Hi j9k22
Here's the link to help you with how to find a good provider: http://www.feast-ed.org/?page=ChoosingProviders. I am not in U.S. so I don't know about the treatment center you mention but maybe someone who does will chime in. Their web says they offer individualized approach but you still don't know for sure what kind of care your D needs. Also, what kind of care did your D have had in the last 18 months? Where is she at as far as her eating and weight? I totally understand the money issue, we all do. It sucks really bad. I lost some money too for my D's final grad school trip she didn't end up going and camps. Maybe you can sell those costumes? 
I am sure someone will know more to point you to the right place in your area. Hang in there.xx
j9k22

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Reply with quote  #3 
Thank you. When you say I don't know what kind of care my D needs, do you mean IP versus OP therapy? For the last 18 months she hasn't had much care. I did get my daughter a therapist when I found laxatives in her room for the second time. This was a few months after the pediatrician recommended the outpatient program mentioned here. So I got my daughter a therapist, then saw the nutritionist that we had seen a year before but had to stop seeing because her insurance didn't cover her services. Then the insurance did cover her services so we saw her the therapist also and then and Adolescent specialists that specialized in eating disorders that was recommended by the nutritionist. But then I didn't appreciate the nutritionist and the Adolescent specialist parking at are not eating dairy foods. I personally don't think they're healthy but at this point if it gets my daughter back to her healthy weight I don't care anymore
j9k22

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Reply with quote  #4 
But then it got too hectic to keep up with all these appointments. My D seemed to be doing well. She had a social life, a job was doing well in school. I wasn't so sure she needed IP as the therapist suggested. Summer came we stopped going to the appointments. In the August, swim team resumed. 4 nights a week of dance after swim resumed also. My daughter wasn't taking in enough calories. Now she hasn't had her period since probably last July or August. Not good! I realize I need to get her treatment. Now in my gut I'm starting to worry that if this HPA/Lifewell IOP program isn't FBT it will be a waste of time. Maybe when they call to do an evaluation on Monday I will say I'm not sure. I should look into the San Diego one. Or maybe Ohio there is a 5 day intensive I just don't know how I am going to afford this. Are there any good intensive programs in NYC area where I am?
martican

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Reply with quote  #5 
Yes, that's what I meant what kind of care. I just found your other post and read it, so now I am up to date 😉 You got some good advice there, and I can offer my experience -  I was able to have my D to gain without dairy (her gastroenterologist eliminated it bc she has Eosinophilic Esophagitis EoE and possibly she is allergic to it). I did a lot of coconut cream smoothies. We went back to dairy (she was put on steroids) but her results showed increased EoE again. We are not vegan/vegetarian as a family so for me it is challenging to cook without dairy for her. But, what can I do.
If the doctor recommended outpatient months ago, I would make sure she gets a full assessment whether she is medically stable (blood work, ECG...). Your D doesn't really need a nutritionist anyway, and depends how deep she is in AN (what percentile she is comparing to what she should be on her growth chart) even therapy might not be useful as her perspective is heavily distorted. I haven't found this forum until after a year my D was struggling and stagnating and all the advice from the forum the biggest booster in my D's way to recovery. 
I totally get it that it will be a challenge to turn your 17 y.o. eating habits around. You can find some leverage (her phone, internet) to get her to eat. Most importantly, she shouldn't be around to see what you are putting in the meals or smoothies. You can start with "healthy" smoothies that contain 1000 cals. I add vegetable oil in them, it doesn't affect the taste. My D doesn't like PB or almond butter in them so I substitute this way. 
The best thing in confusion and stress is the plan. Get her assessed and start sneaking calories in for starters. Take time for yourself if you can because this will be a tough fight and for a long haul. Luckily, we are here to support you or if you need to vent xx
j9k22

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Reply with quote  #6 
Thank you for sharing your experience. I am so glad I found this forum.
EC_Mom

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Reply with quote  #7 
Let me add a practical tip regarding all the payment for dance: If you have a doctor's note that she is unable to participate in physical activity, they might refund you some of the money or retain it for use in the future. We did this at my d's dance program. They put it on pause, kept the money as credit to future use. She went back a year later (not ballet, and only twice a week).
tina72

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Reply with quote  #8 
Hi j9k22,
you can ask them if they are doing FBT and you will find a lot of threats here what to ask in the first appointment (it would be best to do it without your d to be able to speak openly). If you have a FBT therapist with a waiting list until April, get her name on there, too, so you have a plan B. April is not so far away.

The difference between IP and outpatient programm is that a) your d can go to school but b) you will need to have a plan for all the meals in school to be supervised. And it depends on the medical state of your d if she is able to go to school. Mine was to weak to do that in the first 4 months. Then she went back to school but we fetched her up for lunch every day and brought her back then. Some parents go to school for lunch and eat with their child in a seperate room if possible. Some have a person in school who supervises lunch. You need to have a plan for that because what you do not SEE that it is eaten is not eaten mostly.

Dance class: my d is dancing, too, and she had to stop it for 4 months last year. We talked to the dance school and gave them a medical paper from our GP and they set our contract on "pause" and she had a voucher to start it again when healthy enough. That was a big incentive for her and helped her to work with us. She only lost one course and could join in the next one (it was only 1,5 hours a week). You can keep the costumes or sell them if she need another size then, but I am sure she can go back to dancing (maybe less much).

If you can get an outpatient place in your region, try that, but have a plan for the rest of the day. If it works and she gaines 500-1000g a week, o.k., if not or if she loses more weight with that, she will need a higher level of care. It is a try and error thing. Every patient is different. If she needs IP, do that.

Try to see what plan they have and how they will work with you together. Try to be open for diary for some time x. I know that there is a discussion about that in the internet and with some meds. But it is only a few meds that have the opinion that diary is poison. It is (as always) a question of amount. Every food is poisonous if you eat too much of it. If you eat only fast food, that is unhealthy, but it is as unhealthy to eat only salad. A good mixture of everything is what our bodies are made for. 
Please take a bone check of yourself, too, when your d has a dexa scan. You need to be fit to help her. My grandma had osteoporosis because they had no diary in WW2 for nearly 8 years and she was suffering very much from that.

As the others said, the therapist and the dietitian might not be necessary for your d at the moment. She "only" needs to eat and to gain weight. The therapist and the dietitian are more for you to help you with refeeding and to get an idea how to get 3000-6000 calories on a small footprint and how to get your d to eat. They should help you with that and not say things like "don´t be the food police", "she will eat if she has some insight", "it is about control, you need to give her some control about food".
Looking back my d said that the therapy sessions where totally lost time for her. She had no problems to solve besides the eating. And it didn´t help her with eating to talk to the therapist. It helped her to sit with me at the table and be asked to eat what was on the plate.
After WR she did not need a therapist any more because she did not have depression any more and her mood was nearly normal for a teenager [wink]

Tina72
j9k22

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Reply with quote  #9 
Thank you. Great advice!
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