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dc

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My daughter started college last Fall (Freshman). She has weight restored for 4 years and we have a relapse
prevention plan in place. The college health center knows her history and she is doing weekly weigh-in and seeing
the dietitian there. This semester her weight dropped a lot (>10 pounds) so we ask her to take medical leave but she resisted so badly and told us that she will never take medical leave but will try to gain weight. So we emailed the health center medical team and also deans about our concerns and hope school will recommend her to take medical leave. The school had a meeting with us and they did push her to try harder (stop exercising, increase food intakes etc.) but they think her weight is not that bad (BMI not below 18) yet and her state is still good (based on school's psychologist) so they don't recommend her take medical leave now. I am wondering if it comes to a point (things getting worse) that we think she needs to start the treatment immediately but she insists not taking medical leave, what can we do? School said she has to sign the form and we have to work with her ourselves if we want her to take medical leave. So if she doesn't sign the form, we cannot force her as she is an adult now. Does the relapse prevention plan she signed have any legal affect?

Thank you!


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16 yr old d Dx Feb 2012. WR June 2012. Now she is in Phase III and enjoy her study and activities. Try to give the control back to her but still keep vigilant. 
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Foodsupport_AUS

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Reply with quote  #2 
Sorry that D has taken some steps backwards. Clearly the relapse plan has some flaws in it, given she is not abiding by the agreement. I know nothing about US law, but I know in Australia that there is definitely no legal bind for the relapse plan. It is all about leverage. Can you withdraw financial support if she doesn't accept your ruling? The delicate dance of managing older kids can be really tricky. They are legally adults, and can indeed be difficult to convince of what they need to do. 
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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.
melstevUK

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Reply with quote  #3 
dc,

Sorry for what you are going through.  How far is d away from holidays?  Will she be home for Easter and how much leave will she have?  As she has lost ten pounds it is likely that the illness has got a strong hold again and even though she has intentions of trying to stop weight dropping, her calculations around how much food she needs to maintain or increase will be skewed.

Is there any chance of getting a dietitian put in place really quickly and for your d to get that as a line of support?  It is a real balancing act at this stage because she won't want to mess up her studies and her timetable for the year and this is understandable.   But you don't want things to get worse - I doubt very much that you can rely on a psychologist's report because d will be telling everyone she is fine, and if she is completing the work they will take this as evidence that it is true.  They will have no idea just how much weight loss impacts on the brain because they won't have an understanding about the illness.

If d will be home for holidays - maybe give her until then, and then do your best to reverse what is happening when she is back at home.



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melstevUK

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Oops, sorry - she is seeing a dietitian already.  Had read your post too quickly.  Why do you not contact the dietitian and ask her to take a more pro-active stance, check out what she is eating and get increases put in?  I would certainly be letting her know just how serious things are.
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mjkz

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Reply with quote  #5 
Quote:
Does the relapse prevention plan she signed have any legal affect?


I don't think it does but you should keep to it and whatever consequences are spelled out in the contract for noncompliance.  If you feel she needs to take a medical leave and she will not, I'd stop funding anything to help her and let the college know that as an adult, she is now the person who will be paying all the bills.  She doesn't have to follow it but you can still follow through and you should follow through or it isn't worth the paper it is written on.  I would also send the college a letter letting them know that as they are not supporting you, you are going to hold them legally responsible for any bad outcome should she continue to deteriorate.  I would actually have an attorney write that letter so that they know you mean business.  My daughter did something similar and I had my attorney draft a letter letting the administration know that they were responsible for my daughter's health along with a timeline of how she deteriorated before.  She was given a medical leave within about a month of the administration getting that letter.

I would also keep encouraging her to eat more and regain the weight.  I think Mel's idea of contacting her dietitian to have her/him take a more proactive stance and make sure that she/he is increasing the meal plan, etc. so that she has the opportunity to regain the weight lost.  If she needs to come home for Easter(which it sounds like she does), you might call her and let her know when you will be picking her up from school for the holidays, etc. I'd just proceed like we were following the signed contract.
Torie

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Reply with quote  #6 
Hi dc, I'm so sorry you are having this difficulty.

I went back and re-read a few of your old posts to help put the current situation in context.  I'm confused because you wrote this in May (2016):  " I have to admit that my daughter started to relapse under our noses. I know what needs to do and I have done that before when we helped her to restore her weight four years ago. She is not going to college this fall. Instead we are going to re-feed her again to increase her weight until her period will continuously come back for at least 3 times. It will be a tough journey and I am not afraid of going through that journey again,"
but I seem to be missing the rest of the story and how she ended up in college this fall.

Then in November, you wrote, "Currently my wife has been helping her to follow the meal plan in campus. Starting from eating 3 meals and 2 snacks with her, then 2 meals and 2 snacks,  1 meal and 1 snack, and 0 meal and 0 snack."

Is your wife eating with your d again?

I agree with the others that you need to use whatever leverage you have, and the sooner the better.  

Wishing you and your d and the rest of your family all the best,

-Torie



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dc

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Reply with quote  #7 
All,

Thanks for your valuable feedback. In my previous posts, I didn't tell the whole story about my daughter. As parents, we had done a very good job in D's 4 years' high school. Her weight has always been maintaining within the normal range. She was very successful on both academic performance and sports. After graduated from high school last May, we thought that D needs more practice on independent eating for college life. D had two issues: restrictive eating (i.e. don't eat read meat) and over exercising (running). We sent her to a local ERC. She lost 7 lbs under the therapists' supervision within 3 weeks. We took her home and brought her weight back to normal range. She did IOP treatment in another ERC for about 6 weeks.

Last September she went to a prestigious university far away from our home. She survived for one semester with my wife's support in school. But starting from this semester, she continuously loses weight. The current weight is below the red zone. We have the relapse prevention plan signed by D, us and therapists. The problem is that when we asked the university to let D to take medical leave, the university thought D's medical condition was not that bad and didn't let her to do it unless she wants to. Of course, D doesn't want to leave school. Currently the university has a team which includes dietitian, psychologist, RN and school advisers to support her. But D is always lying about her weight. The difference is about 4 to 5 lbs. We have showed the school with the evidence and asked D to be honest about her weighing. Her BMI we measured last week was about 18.  D can eat independently enough food about 3000 ~ 3,500 calories per day. Because she keeps running, it is difficult to gain weight. The school has asked her to write down a document that she will volunteer to stop running until her weight has been restored. We know it is difficult for her to do that, but we will see the result soon. There are about 9 weeks left before this semester ends. We can't do anything during that period unless her health condition is getting really bad. I guess that the only leverage we have is the tuition for next semester if she can't restore her weight by herself.

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16 yr old d Dx Feb 2012. WR June 2012. Now she is in Phase III and enjoy her study and activities. Try to give the control back to her but still keep vigilant. 
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"The darkest night is often the bridge to the brightest tomorrow."
mjkz

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Reply with quote  #8 
I think the university deserves a healthy dose of blame in this too.  It is totally reprehensible for them not to honor the contract you and daughter signed.  I would still have my attorney draft a letter letting the university know that you will hold them responsible for any health issues that happen to your daughter starting from the day she deviated from the contract and they supported her not following the contract.  You do have more leverage than waiting for 9 weeks for things to deteriorate further.
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