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doris

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Reply with quote  #1 
Hi, My daughter has just been diagnosed with anorexia after getting her to the GP last week. We have an appointment with CAMHS (we're in the UK) on Tuesday but she is restricting her food intake to just 200ish calories a day. Everything I've read points to "refeeding" to try and put weight on but at this intake she is only going to get worse. She insists on only fruit and veg - she did have some chicken (about 20g) yesterday evening but she is constantly working out how many calories she's having... I feel lost and confused as to how to progress with this, I can't "hide" calories in plain fruit or veg. Any help or advice would be very much appreciated x
melstevUK

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Reply with quote  #2 
Hi Doris,

Welcome.  So sorry you have had to find us but at least you have landed on the best website in the world for getting help and support from people who really understand these illnesses.

Right now your concern is to ensure she is getting enough fluids in between now and Tuesday - if she refuses to drink anything, you will need to insist on taking her to A and E to check that she is not dehydrated, which will be a medical emergency.  

I don't know what her weight is or her bmi - but at this intake level she will need hospitalised pretty quickly I imagine.  However, if you can get her started eating more at home and get the weight reversal going, then it can be avoided.  It partly depends on the strength and commitment of your team.  At least your GP has got her fast-tracked through the system, by the sound of it.

What you can do is tell your d that she has a life threatening illness, that you will not stand by and watch her die, that she will need to learn to start eating again and putting on weight - and which you will know will be absolutely terrifying for her, but that you will help her fight this illness.  Ensure that she understands that you know this is an illness, and that she is not 'choosing' to be ill - whatever her behaviours and whatever she says.  Think of her brain having been 'hijacked'.  In a nutshell she has a biological and genetic susceptibility of going down this path after too much weight loss, which 'triggers' the switch in the brain.

There is lots of information which you can find on the website, when you have time to explore in more detail.

In the meantime, can you create a table for a weekly meal plan, with six boxes for each day of the week - and it is your job to help her fill it.  If you can get her to sit down with you, at a time when she is not eating - and tell her that she needs to eat more than fruit and vegetables.  Offer half a glass of milk and a rich tea biscuit for a start.  Don't deviate - just give her these two choices and ensure you get tomorrow filled with something like a banana (whole one) for breakfast, half a glass of milk for a snack, a large plate of vegetables she is currently eating (could you persuade her to eat them as a soup, if you boiled them up with stock? - she will see the stock as calories but try and stand your ground, because this at least resembles a 'normal' meal), another half glass of milk for a snack, fruit with zero Greek yoghurt for tea and then another half glass of milk for supper.  If you can get that agreed and down her - you will have at least started the reversal and challenged successfully the resistance which you will meet.  Don't be surprised if she screams and shouts - sit there calmly and expect her to come back to the table.  Also, she should be drinking freely - even tea or coffee without milk, or low calorie juice will be ok in terms of fluids.  

Other people will tell you to push for more but right at this moment if you can get double the calories and even some milk and biscuits in tomorrow - that will be a start.  

I would ask for an immediate hospitalisation at the moment - they might even consider it themselves, but specialist places are desperately in short supply - so you can't guarantee what their response will be.  However, this is a pretty desperate situation if her intake has become so low so I hope they will offer it.

It's going to be a long and tough journey, with a lot of heartache - but many others have walked this journey and come out the other side.

Hugs.  Others will be along soon.

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Believe you can and you're halfway there.
Theodore Roosevelt.
Sotired

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Reply with quote  #3 
Hi Doris
You can try 'life stops until you eat' perhaps.this means that everything she loves disappears until after she has eaten-no phone,no computer,no tv.in our house we also tried no going anywhere until food was eaten. Once the food is eaten she can have her phone back-but make sure you block any pro ana sites and calorie counting apps.
Depending on how much weight she has already lost I would be going back to your gp tomorrow to have your daughters obs checked.make sure your gp has done an orthostatic heart rate.first the doc takes the heart rate lying down.then standing up.this gives a much clearer indication of how hard the heart is having to work.if things don't look good then your daughter may have to go to hospital to be checked out there.my daughter was first admitted for dehydration for example.
Many here have success with plating up the food themselves.so you prep and serve all the food your d used to eat and then sit there with her until it is done.
We required a higher level of care in our case so my d was refed via NG tube in hospital and then we tried fbt both at the hospital and at home.fbt is family based therapy and it's based on the theory that the family is best placed to re feed their child.they get fed six times a day-3 meals,3snacks.you choose all the food.
If you notice your daughter looking pale,shaky,very cold hands and feet or she faints-go straight to a&e and get her checked out.this illness can be deadly so always better safe than sorry.
Others will chime in soon, I just wanted to give you a few things to know about and try.
Good luck

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Sotired42
Foodsupport_AUS

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Reply with quote  #4 
Welcome to the forum so sorry that you have had to find your way here. A new diagnosis of AN is very frightening and the age old problem of how to get someone with anorexia to eat is something that all of us with children with AN have had to deal with at some time. There are some great Hall of Fame posts about how to get started at re-feeding. It is normal for your D to resist your efforts, but it is also important for you to insist that she does eat more food. You can make a plan of adding in extras over and above what she is currently eating every day. Stop all activity. 
As others have said if you are really concerned she may need assessment in A&E. If she is not able to eat and unable to get out of her current dire situation with your help she will need to be admitted to hospital. Using this as a threat is unlikely to be helpful, rather the goal for you is to make it so that she feels she has no choice but to eat. 

Please ask lots of questions. 

__________________
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Mamaroo

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Reply with quote  #5 
Hi Doris, sorry to hear about your d. Min d also restricted to the point that she was only having around 1000 kJ per day. My d had nothing left to live for, constantly crying. She ended up I in IP for 2 weeks to stabilise her and we refed her at home. First slowly, as Melstev said. Start with her safe food and add to it.

Are you familiar with the Minnesota semi starvation project? I'm just going to quote from Wikipedia:
"The investigation was designed to determine the physiological and psychological effects of severe and prolonged dietary restriction and the effectiveness of dietary rehabilitation strategies. The study was divided into three phases: A twelve-week control phase, where physiological and psychological observations were collected to establish a baseline for each subject; a 24-week starvation phase, during which the caloric intake of each subject was drastically reduced—causing each participant to lose an average of 25% of their pre-starvation body weight; and finally a recovery phase, in which various rehabilitative diets were tried to re-nourish the volunteers. Two subjects were dismissed for failing to maintain the dietary restrictions imposed during the starvation phase of the experiment, and the data for two others were not used in the analysis of the results.

Among the conclusions from the study was the confirmation that prolonged semi-starvation produces significant increases in depression, hysteria and hypochondriasis as measured using the Minnesota Multiphasic Personality Inventory. Indeed, most of the subjects experienced periods of severe emotional distress and depression.There were extreme reactions to the psychological effects during the experiment including self-mutilation (one subject amputated three fingers of his hand with an axe, though the subject was unsure if he had done so intentionally or accidentally). Participants exhibited a preoccupation with food, both during the starvation period and the rehabilitation phase. Sexual interest was drastically reduced, and the volunteers showed signs of social withdrawal and isolation.

One of the crucial observations of the Minnesota Starvation Experiment discussed by a number of researchers in the nutritional sciences—including Ancel Keys—is that the physical effects of the induced semi-starvation during the study closely approximate the conditions experienced by people with a range of eating disorders such as anorexia nervosa and bulimia nervosa. As a result of the study it has been postulated that many of the profound social and psychological effects of these disorders may result from undernutrition, and recovery depends on physical re-nourishment as well as psychological treatment."

Here are more information about the experiment: https://archive.org/details/MenAndHunger

My d didn't want to eat with the rest of the family, so she ate in her room with me distracting her by playing candy crush. Remember that if you don't see her eat, the food is not going in. They are very clever hiding food in their clothes or even in their mouth and later spitting it out. Speaking of which, she should go to the bathroom before every meal and not go after a meal unsupervised due to the possibility of purging.

My d became very distressed during refeeding and started to cut herself. We had to hide the knives, scissors, needles etc. It was just the ED, it passed as the weight got on, although with initial weight gain, her anxiety increased. Today she is at a healthy weight and we are tackling the last ED symptoms. You'll get there as well 😁.

Sending you lots of hugs 🤗🤗🤗🤗

__________________
D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for a year and WR at age 11 in March 2017. Challenging fear foods and behaviours now.
tina72

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Reply with quote  #6 
Hi Doris,
we had a similar problem in january before our d went IP. She took only 500 cal per day and didn´t drink any more so she got dehydrated. Thats an emergeny case. Try to get her to ER if she doesn´t drink more. Try to make her drink smoothies. That looks like fruit/vegetable and you can hide some canola oil in it. Don´t let her see when you prepare it. Make her drink a little shot and the a little glas. Try to increase that up to 500 ml a day. Tell her she has to go to the ER if the doesn´t drink and will get a tube then. If that doesn´t work, there is no other way than ER. Sorry to say this but that is life threatening.
Tina72
daisy1779

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Reply with quote  #7 
Hi I have recently been in a similar position to you, my daughter 13 gradually restricted more and more and 5 weeks ago was probably eating 200 calories per day at most. We were already under camhs (uk) due to an overdose in April and were awaiting an appointment with the eating disorder team. I ended up taking my daughter to a&e and she has been In hospital since. I wasn't sure what they would say when I took her and was so worried that they would send us away but thankfully they took us very seriously and she was admitted within an hour as her blood pressure/pulse/blood sugars & temp were all dangerously low. I'm still very new to this but would say trust your instincts. I asked every professional we had seen if/when I should take her to a&e and no one really gave me an answer, in the end it was my partner that pushed me to take her and I am so glad he did. She's still restricting at times in hospital and it's looking like she will need tier 4 but she's safe and they will tube feed if necessary (she has been close to having it done)
Holroyd957

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Posts: 11
Reply with quote  #8 
Hi if your D has only been eating 200kcals/day she is at high risk of refeeding syndrome and should initially be refed on a hospital ward where her electrlolyes and cardiac function can be closely monitored. I would suggest taking her to a&e and taking with you a copy of MARSIPAN guidelines.
seaglass

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Reply with quote  #9 
First of all kudos to your GP for getting you a CAHMS appointment so quickly. Some people face an agonising wait.

200 cals a day is worrying. Did the GP check blood pressure (sitting then standing) and do an ECG? Did she/he check bloods? All that will be done at CAHMS but you might want to insist checks are done tomorrow just to be sure?

At this initial point any increase in food is a step in the right direction. If she really will only eat fruit and veg go for avocados and bananas etc... try a smoothie (add rapeseed oil and maybe almond milk if she will drink it). Are there any recent foods she would eat before restricting? If so get her to eat them (e.g. Dry cereal/crackers etc).

It's so scary and worrying when you've just got a diagnosis. At least you've not got a long wait to start treatment and get support and advice.

Will she drink milk? Hot choc? ..

Over the next few weeks you'll learn more about starting refeeding. Hang in there and ask qs here. It's an amazing forum.

toothfairy

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Reply with quote  #10 
Hi there,
Did your D eat & drink today?
If not or if only 200 cals, please take her to A &. E tonight as she could be at serious risk.
Please let us know how you are doing.
Best of luck

__________________
Son,DX with AN, (purging type) in 2015 ,had 4 months immediate inpatient,then FBT at home since. He is now in strong recovery, (Phase 3 ) and Living life to the full, like a "normal"[biggrin] teen. This is with thanks to ATDT. Hoping to get him into full recovery and remission one day at a time. Getting him to a much higher weight, and with a much higher calorie plan than his clinicians gave him as a target, was instrumental to getting him to the strong recovery that he is in now. Food is the medicine.
BattyMatty_UK

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Reply with quote  #11 
Hi Doris, How are things going? I notice that it's a few days since you posted.

Lots of good advice above. I know that often it can be a case of 'easier said than done' with this kind of thing, but the leverage ideas mentioned above sound like plans. And as MelStev says, make it clear that you're not going to give up on her.

Quote:
What you can do is tell your d that she has a life threatening illness, that you will not stand by and watch her die, that she will need to learn to start eating again and putting on weight - and which you will know will be absolutely terrifying for her, but that you will help her fight this illness.  Ensure that she understands that you know this is an illness, and that she is not 'choosing' to be ill - whatever her behaviours and whatever she says.  Think of her brain having been 'hijacked'.  In a nutshell she has a biological and genetic susceptibility of going down this path after too much weight loss, which 'triggers' the switch in the brain.

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Bev Mattocks, mother of 23-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver.
doris

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Reply with quote  #12 
So I have tried to reply to all you lovely people who reached out to me a few times but it really is an emotional rollercoaster isn't it?
Since our initial Camhs appointment we have been meeting them fairly regularly and in regards to intake DD is doing much better. She is drinking plenty of water and three meals a day. We are working on increasing to 3 snacks as well. She is still massively resistant to anything other than fruit veg plain meat. Sometimes she will eat eggs and the tiniest amount of cheese she has milk in porridge for breakfast and another glass of milk as a snack before bed. Yesterday she eat a few nuts. In many ways I feel we are heading in the right direction, she probably averages around 1500-1800 calories a day. Butt, she has now gone back to school, her packed lunch is just an avocado and a mango. She has lost 2lbs this week so now weighs less than on our first camhs appointment. I get that she's not going to suddenly, magically get better but my god I didn't realise it was going to be this all consuming to care for her. And, she only has around 10lb to gain to be in her healthy weight range.

A real positive is my husband came to the camhs meeting yesterday for the first time and he is now beginning to realise the depths of the illness. He has gone from being an ostrich to a kangaroo!!

Once again thank you to those that replied to my initial plea for help. Your messages of support and advice were / are hugely appreciated. I'm sorry it's just only now I feel able to update you. X
Foodsupport_AUS

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Reply with quote  #13 
Oh dear, it sounds like although you have made some huge changes in the last six weeks you are still really struggling. From the date of your first post I gather you have been trying re-feeding for six weeks and so far despite having increased her intake have only slowed the loss rather than gained anything. I am sure that you are trying your best, ED is one tricky beast. 

One suggestion would be to take her out of school. Given there is no reliability that she will eat anything at school, unless you have arranged to supervise her, perhaps she would be better eating at home. However depending on how she is going mentally you may be able to use school as a leverage to get her to eat more, if you can arrange the supervision for lunches and morning tea. Some kids are keen to continue to socialise and go to school so you can take that opportunity to for example insist on a large breakfast before leaving for school, insist on supervision at school for meals etc. 

I am sorry to tell you, but it is also likely that your D will need to gain more than the 10lbs to get her "to her healthy weight range". Many here have found goal weights have been underestimated in many cases, especially when suggested at the start of an illness.

__________________
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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