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abby

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Reply with quote  #1 
Usually, my sister eats by herself and tries to hide how much she's eating. Today, I watched her fix and eat her usual meals. Tomorrow is her dietician's appointment, so I wanted to know how much she has been eating to know what I'm starting with......

Meal 1 (3 am): 2 pieces of low-cal bread, 6 slices of chicken deli meat, ~1 tbsp hemp protein powder mixed with water, and 1 english muffin

Meal 2 (10:00 am): 2 pieces of low-cal bread, 6 slices of chicken deli meat, ~1 tbsp hemp protein powder mixed with water, and 1 english muffin

Meal 3 (4 pm): 2 pieces of low-cal bread, 6 slices of chicken deli meat, ~1 tbsp non-fat plain yogurt, and 1 Lenny and Larry's cookie

I knew she ate sometime in the middle of the night, so I slept out in the living room near the kitchen. I had no idea she was eating this little. Although she says that sometime she adds another meal that's the same as meal 3, I have a hard time believing it. She also has these strange rituals, like picking "fat" off of all her deli meat, microwaving her english muffins EXACTLY 13 seconds, picking off all the chocolate chips on her cookie and eating them at the end, squishing her bread/english muffins into little balls and dipping them in either her protein powder mixture or yogurt, and placing her cookie in the freezer for 15 minutes before she eats it. There are probably even more rituals, but these are the ones that are really noticeable. Does anyone have experience with breaking food rituals? What did you do? Should I focus on increasing her food intake first and deal with the rituals later? Her mealtimes are very strange as well. I know the phrase "rip off the band-aid" is popular on this forum, but I feel like it might be too much to expect from her. She's fragile, mentally and physically, and has been doing this exact diet for months/years (?). What's your opinion on how we should transition to normalcy?

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22 y.o. sister to a 20 y.o. sister with RAN b/p-subtype who's been struggling for 7 years. Never recovered fully---never been weight restored let alone pre-ED weight. Gonna start Maudsley for a "grown-up" with ED?

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes?
" Matthew 6:25
Torie

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Reply with quote  #2 
Hi Abby - Good work finding out her intake.  Personally, I wouldn't worry about the weird rituals for now - they all seem to have their own weird rituals, but what really matters is getting the nutrition in.  I'd just focus on calories for the moment, along with upping the fats.

Good luck at the appointment - please let us know how it goes. xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Kali

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Reply with quote  #3 

Hi Abby

It was a great idea for you to see what your sister is actually eating; and for you to go tomorrow with her to the dietician.

Can you tell your s. that you are going to help her by preparing her food for her? Keep her out of the kitchen while you are preparing the meals. I am trying to think of some ideas for you. Start slowly. You know she will eat bread, yoghurt, chicken and cookies so why not try to build on that to begin with? Also try to make the dinner atmosphere as pleasant as possible and sit and eat with her. Use pretty china, have some flowers on the table, play some calming music in the background. Make conversation about things she is interested in. Do your best to make her feel valued and loved. Make mealtimes feel as safe as possible since your sister is going to feel really really stressed. Don't get up from the meal until she has eaten everything. Since she is binge purge subtype someone will need to sit with her after meals also for at least an hour if not more. Can you watch tv together or go for a walk with the dog after meals.  If she is really struggling to able to finish the meals you can offer her the choice of an ensure or boost instead. I think there is one that has 500 calories that you can buy. One thing I thought helped was that I ate the exact same things as my d and still do; our plates are identical. I didn't really do much band-aid ripping, but instead took the slow and steady approach while remaining firm that eating is required.

This is how they did it in the RTC my d was in: When refeeding the amount of calories is gradually increased. At first you just want to get her more accustomed to eating. So they start with say, 1800 calories a day. Then after a patient is able to do that for a week, they go to 2100 and keep increasing every few days by another 300 calories. She may need to get up around 3700 a week eventually for good weight gain. 

Here is a simple menu for a couple of days you might want to try and see how it goes. Her portions may be small at first but you can increase them as you go along. Since she seems to be repeating many of the same foods the idea is to develop a list of things she will eat with adequate calories and food groups and then you can repeat those foods as she gets accustomed to them and help her to create new habits regarding food instead of the maladaptive food habits she has at the moment.

Day 1: Breakfast: cheerios and banana with milk and a good multivitamin.

Lunch: Pizza english muffin: spaghetti sauce, cheese on top of an english muffin, baked in the oven. Tomato soup.
Juice
Fruit

Dinner: roast chicken with potatos and grilled asparagus drizzled with oil..
Juice
Cookie for dessert 

Snack: granola or protein bar

Day 2: Breakfast: scrambled eggs with cheese and heavy cream and home fried potatoes with a glass of milk and a good multivitamin

Lunch: Chicken sandwich with good bread (not low calorie) maybe not lunchmeat but real chicken from the night before.
Juice
Cookie

Dinner: Avocado toast with good bread and feta cheese and tomato. 
Juice
Cookie

Snack: tortilla chips and salsa

These meals take a few of the things she is already eating and presents them in a different way and also adds in some new things.

Another thing you could do is to meet with the dietician without your sister for as many times as you need to and have her/him help you create a mealplan for your sister for refeeding and advise you in general. The dietician knows your sister and might have some good ideas. The dietician can reinforce the ideas of you taking over in the kitchen and preparing meals, as well as recommending a meal plan for your s. to follow. I always found it was good to have another voice to add to the mix advising d. to eat so the dietician can be helpful in that way.

Start reading the calorie labels when you do the shopping and always choose the higher calorie items.
Full fat milk, 100% juice, etc, no diet or low fat food should be in the house. Always serve a caloric drink with meals.

Let us know how things go and how we can best support you. Expect to see anxiety and resistance however do your best to stay calm and don't get upset with her. Keep encouraging her to eat and be firm but loving.

Kali





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toothfairy

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Reply with quote  #4 
Hi Abby,
How are things, Kali has posted some great tip's.
I hope you are doing ok.
Best wishes ,
TF

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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) ,  Now Phase  2 , making progress every day. Living life to the full like a normal teen. We are not out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT.
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