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pettelly

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My daughter is 13. Over the summer she decided to lose some weight and it's deteriorated from there. She's 165cm and was about 55kg in June. She's now 49kg and has been increasingly restricting her eating. Her weight is still within normal range but I think it's too low for her frame. She has lactose intolerance and gets upset stomachs easily so at first she was framing it all around that which meant we thought there was less of an issue.

Now we realised how much weight she has lost and that she's actually got an eating disorder. We looked at what she's been buying for lunch on her card (back 2 weeks now) and it's either a salad box or really small portions of food by weight (100-200g). Breakfast is usually a chopped apple with yoghurt. She finally opened up to us about what's happening with her and she's admitted she has a problem and that she doesn't want to lose more weight (but doesn't want to gain back because she was 'fat' before). 

Lots of cuddles and tears and she came in and slept with us last night (has happened for a loooong time) because she couldn't sleep last night because she's so scared of being 'fat again'. 

She's agreed to work with us on this but it's hard work!!! Half an hour negotiations and tears to get her to eat a slice of bread with avocado for breakfast this morning.

Should we get professional help for this? I'm scared this is bigger than we are able to handle. Any tips or advice on what we should do? She has a typical perfectionist, over-achiever personality, always harsh on herself with everything. 

Foodsupport_AUS

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Reply with quote  #2 
Welcome to the forum. Sorry that you have had to find your way here. 

It does sound like you have a problem on your hands, but also great that your D has acknowledged there is an issue and that she says she doesn't want to lose any more weight. 

You ask should you get professional help? An impossible question to answer given what you have mentioned. Much of that will depend on what happens from here on in, as well as what help is available to you. Your D may respond well to being assisted with eating and things may settle down with regular meals, she may on the other hand really struggle and her anxiety may get worse as may her mood. If you haven't got professional help I would certainly be looking around as to what is available and how easily available is it. Then you can decide to act quickly if things are not going well. A clear plan and back ups are always helpful. 

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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.
Torie

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Reply with quote  #3 
Quote:
Originally Posted by pettelly
[S]he's admitted she has a problem and that she doesn't want to lose more weight (but doesn't want to gain back because she was 'fat' before). 


Yes, well, the problem she has is that she doesn't weigh enough.  And that she doesn't want to (read: is terrified of) regaining the weight she needs.  That's been the story for most of us here.

It is extraordinarily rare for them to be able to get to a better place, mental health-wise, without regaining ALL the weight they lost, and then most often adding a few more pounds.  Meanwhile, they badly, madly, passionately want to keep off the weight they have lost.

That was my d's story, too.  Her clueless pediatrician told her it was OK not to regain the weight ... while my d sank deeper and deeper into depression and suicidal thinking.  Her therapist recommended blind weighing (where the patient doesn't see the weight).  That works for some - worth a try if the team wants to go that way - but it was less traumatic for my d to be able to know what she weighed to calm her fears that she had regained more than she had.  So your mileage may vary.

In the end, the advice I got here on ATDT turns out to be correct - she did indeed need to regain ALL the weight she had lost, and then some.  This, even though her weight, even at the lowest, was not "unhealthy" according to the charts.  It was most definitely an unhealthy weight for my d, though.  As is your d's current weight.

So my advice is to refrain from talking about numbers with her (calories, weight, size, etc.).  MAKE NO PROMISES ABOUT HOW MUCH WEIGHT SHE NEEDS TO GAIN.  And feed her.  Fats are super-important for brain healing and can add vital calories without creating a mountain of food.  You can whisk canola oil (rapeseed oil in the UK) into everything from yogurt and sauces to shakes and soup.  You can experiment to see how much you can add to a serving without changing the taste or texture.

Oh, one other tip I learned here:  Sort of by definition, someone suffering from AN is irrational about things like size shape weight etc.  So there is no point in trying to reason with them on a topic they are irrational about.  That was really hard for me as it was directly opposite my natural parenting style which is very democratic and based on discussion.

Please feel free to ask all the questions you like.  Best of luck. 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  #4 
Dear Petelly,

I'm sorry you have had to join us here and that your daughter is ill, but I hope you will be able to get peer support from others who have walked in your shoes. 
I found that reading and becoming well educated about eating disorders was helpful. There are some resources on the Feast site that you might want to take a look at:

http://www.feast-ed.org/?page=LearningCenter

Eva Musby has written an excellent book which we found helpful during refeeding and she has practical suggestions.

https://www.amazon.com/Anorexia-other-Eating-Disorders-compassionate/dp/0993059805

As far as professional support goes, it is probably wise to start investigating what support options you might have in your area, as Foodsupport suggests. 

I'm sure that other parents will be along to welcome you also and try to suggest helpful strategies. An important thing now could be working to prevent your daughter from losing any more weight and trying to get her weight up and normalize her eating again. Morning smoothies can be helpful for breakfast, made with fruit and yoghurt, and if your daughter is lactose intolerant, either giving her lactaid tablets, or soy or almond milk fortified with calcium. I think that icelandic and greek yoghurt have lower levels of lactose than some of the other yoghurts. (I am lactose intolerant also) There are also some ice cream products without lactose that you could add to the smoothie. If she is having difficulty eating enough for her lunch in school, some parents have found that going in and eating with their kids or having the school nurse eat with their child, has been helpful. 

best wishes,

Kali

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EC_Mom

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Reply with quote  #5 
Welcome to the best place on earth for info and support with ED. Sounds like you also, in addition to all the good suggestions here, need to get her to a pediatrician to make sure she is not dangerously compromised. My d lost only 11 pounds (5 kg) and needed hospitalization for acute malnutrition and to avoid possible heart failure.

Now, the problem is that many, many pediatricians have only learned old-school approaches to ED, e.g. that it's the kid's fault, or the parents' fault, or that there are "underlying issues" causing it, or that it's "all about control". I fired 2 pediatricians along the way for these reasons. 

But among the most important medical tests your d needs is an orthostatic blood pressure check (a specific protocol exists for this, it's cheap and easy), patient lies for awhile and has blood pressure checked, then stands and has it checked again. Blood tests are not definitive of much!

And like everyone said, food is her medicine, you need to require eating, and don't waste energy trying to talk to ED, persuade, or make rational something that is by definition irrational. You have already gotten a good start!
tina72

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Reply with quote  #6 
Hi pettely,
welcome to this forum nobody wants to be member of and congratulations that you have 1. recognized that she has a problem and an ED (which took a lot of time for us to see) and 2. found that wonderful place where you will get a lot of help to get her back on track again.
You ask for "professional help" but the question is what are you expecting. Where do you come from?

There are two different things for you to do now:
1. You must help her to gain weight again. 49 is much too low with this high. She is only 13 so she will grow. She really needs to gain weight. She needs that to keep her body healthy and to cure her brain. Most of the ED thoughts get along with malnutrition. They get better by gaining weight. She will not feel "fat" when she is in a healthy weight range. Her brain needs food and good nutrition and a lot of fat to recover.
2. You may need a doctor to check her blood and her heart rate. Malnutrition and low weight cause a real slow heart rate and a lot of blood problems. The danger is that a lot of doctors don´t know anything (or not enough) about ED. We took our d to the doctor last september when she already lost 10 kg and the doctor said it is puberty and stress from school and we should wait and see. That was a dangerous advice and she nearly lost her life because of that. So you first have to find a doctor who knows as much as possible about ED.

Can you tell us in what region you live? Maybe someone here could tell you a name or a hospital that was good. If there are some FBT therapists in your region, try to contact one. They will help you with refeeding.
As much as I can read by what you have posted I´m sure that your d has RAN. This is a very serious disease and she will not recover without gaining weight. Food is medicine for her. It is great that you made her eat that bread today. That is a good start. Try to make her eat some yoghurt and smoothies where you can hide a lot of butter, cream and oil in it. She will need a lot of calories because loosing weight seems to be very easy, gaining weight is a very hard thing. If you get her to eat and gain about a pound a week that would be wonderful.
Ask, ask, ask. There are a lot of nice people here with kids in good recovery and they have a gold treasure of ideas...
Tina72

pettelly

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Reply with quote  #7 
Thank you for all the kind messages, fantastic advice. 

I've been reading some more and agree that this is beyond us and we really need professional input. I'll make an appointment with our doctor tomorrow. 

She went out with a friend this afternoon to an amusement park and phoned me to say she felt dizzy. I told her to get something to eat but of course she refused because all the options were 'unhealthy'. She came home and was hungry for dinner and ate baked salmon, some salads and a bit of rice (with a lot of cajoling) but refused any dessert which she'd have loved previously. 

She has agreed that I can make her smoothies for breakfast. She thinks they're 'healthy' so has agreed but she doesn't know what I'm planning to stick in there for her!

We're in Denmark - I guess not many people from there? 



sk8r31

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Reply with quote  #8 
Hi pettelly, & welcome.  There is so much great evidence-based information available on the main FEAST website, in addition to the extremely valuable peer support here.

You are wise to be concerned, & to start to help your d regain lost weight immediately.  Unfortunately, things can go south very quickly with restriction, even if your d is within what is considered a 'normal weight range'. 

Our d decided to eat 'more healthfully' at 14, and lost some weight, though not too much.  Then we went on an extended trip, and she virtually stopped eating, complaining of stomach aches etc.  Within a month, she was admitted to our regional Children's Hospital with low pulse rate and orthostatic blood pressure.  She was still within a normal weight range for her height, but the rapid weight loss put her in a very medically compromised position.  A week's stay in hospital stabilized her medically, and then we began the work of refeeding and addressing anxiety issues.

It took us a very long time to find good professional support, as we live in a small town with limited resources.  The recommended RD worked at a diabetes clinic, and she turned out to be a real set back to us, telling us not to be the 'food police' and that our d should be choosing her meals and so on.  Our pediatrician said that my h caused our d's ED, as he has a lot of anxiety himself.

Long story short, we 'fired' our team and found good, evidence-based professional support, though we had to travel 90 miles each way for appointments.  

You may have to educate your medical providers, but hopefully, you can find professionals to support your family who are up to date with best practices in ED care.

Knowledge is power, so read as much as you can, & look at the resources available on the main FEAST site.  In particular, the FEAST Family Guides and the Academy of Eating Disorders Medical Management of EDs pamphlet are a good place to start.

Sending warm support,
sk8r31


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It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
pettelly

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Reply with quote  #9 
OK, first question. She refused dessert. I'd got some ice cream from one of those pretentious (but delicious) ice cream places [wink] which included some flavours she could have. Of course she refused. We had guests so didn't insist but now the guests have gone should I insist she comes down and eat ice cream? Or would I be pushing her too far too fast? No idea what we should do!! 
Torie

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Reply with quote  #10 
I don't know the answer to your question, but if you are going to require her to eat the ice cream, you best be prepared to fight to the finish to get her to actually eat it.  Otherwise, the disordered part of her brain will think it is in charge and can refuse what you require.  An alternative might be to require one or two bites as a start.  

Please keep us posted.  xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
K63

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Reply with quote  #11 
Hi petelly, welcome to the forum. It sounds like your d has admitted she has a problem and she has. Her weight is too low . She needs professional help from specialists who understand eating disorders. While you are awaiting an appointment your d needs full supervision with all meals. If you don't see her eating presume it's not eaten. I found Eva Musby s video "how to help your child eat well and be well " very helpful it helped me understand what is going on in the brain of someone with an eating disorder. Food is their medicine and to them food is the enemy. Staying calm at meal times is essential but also difficult if your daughter is refusing meals. Read as much as possible about the illness . They can hide food during meals in pockets, hoods, up sleeves. Supervise after meals as they may go to the bathroom and make themselves sick. Hope you get professional help soon. I would be refusing to allow her see her friends until she has eaten first.
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Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
deenl

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Reply with quote  #12 
Hi pettelly,

Welcome (I just accidently deleted a long reply to you so I am doing the short version now [comp])

Great you are going to doc. Dizzy spells could signify low blood pressure due to malnourishment. Orthostatic blood pressure (first lying down, then standing) very important as gives indication of pressure on heart muscle which is common esp in younger patients who seem to lose weight very fast.

This is a comprehensive checklist of symptoms you can go through, print out and bring to the doc. Might be worth talking or emailing doc in advance. Ours was an idiot and set us back. Hope yours is better.

As to starting straight away, when we started we had a plan b, c and d ready. Think in terms of a nutritional supplement to drink in case she refuses the food. Also, the ED (we often mentally separate the ED behaviours from the way our kids normally are. It helps to fight the ED while loving our kids like mad) can just explode when challenged. Our first few times included screaming, howling, kicking, spiting, throwing food, etc. Not all kids are like that but are you prepared? Are you and partner/other adults in agreement? Have you warned other kids/neighbours? I always over prepared but very little took me by surprise.

Eva Musby's book is wonderful to help you plan and execute the plan. I recommend downloading it asap if it is possible.

Remember we only share our experiences and we don't know your daughter or your situation. Trust your gut. I used to consider the forum as a smorgasbord of ideas and chose the ones that suited us best. Take what you like and leave the rest.

Warm wishes,
D

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2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, tons of variety in food, stepping back into social life. Sept 2017, back to school full time for the first time in 2 years. Happy and relaxed, just usual non ED hassles. 

  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal. (but don't give up on the plan too soon, maybe it just needs a tweak or a bit more time and determination [wink] )
  • We cannot control the wind but we can direct the sail.
Kali

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Reply with quote  #13 
Hi Pettelly,

As Deenl says, trust your gut and do what feels best for your situation and your family. You could drop the ice cream for this evening and focus on meals for tomorrow. As others have suggested, taking her to the dr. is a good idea. You may want to phone the dr. ahead of time privately and describe some of the behavior you are seeing at home about food, and discussing the recent weight loss.

What you could help her focus on is working towards the goal of her eating 3 meals a day and 2 snacks containing a nourishing, balanced diet and helping to increase her weight. I chose my battles very carefully. The reintroduction of desserts, for us, was a slow process. For desserts, first I started with let's say, a bowl of strawberries. When she had eaten that a few times, I added some sugar, then some homemade whipped cream. When she was able to eat that, I added a small pastry shell under the strawberries and whipped cream. Then we proceeded to pie (fruit and pastry) But that all came much later after weight restoration. Each family is different and others may tackle this differently. Some good breakfasts: oatmeal with raisins, brown sugar, and almonds along with a smoothie. Scrambled eggs with cheddar cheese and fried potatoes and chocolate soy milk.

So my suggestion for right now would be: pay attention to the foods she IS eating. Did she eat Salmon and rice? Great! Make it for dinner once a week. What else WILL she eat? Repeat those foods and see how you can bump up the calories in them. For salmon, for example, you could try broiling it with a butter/indian spice mix and then making raita, with cucumber and full fat yoghurt over it. It tastes great. I also insisted that she drink a caloric drink with every meal, not water. There is also a product called benecalorie, which is tasteless. You can add it to sauces, it is especially good in spaghetti sauce, and it has nutritional value and you can also add it to stir fries with veggies and tofu. One small container has 350 calories and it can be ordered online. The high-calorie thread also has some good suggestions for meals which have a relatively small footprint yet pack a caloric punch. Deenl has also posted some great suggestions for soups. 

https://www.aroundthedinnertable.org/post/high-calorie-suggestions-696425#gsc.tab=0

Håber dette hjaelper! 
Jeg boede i Danmark i otte år men det var for laenge siden! 

Kaerlig Hilsener, 

Kali

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bewell

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Reply with quote  #14 
My daughter is 14 and also lactose intolerant. She has been weight restored for a couple of month now. In the beginning all the food was hard, but the easiest was a shake, because you could put much more calories in it than in any other meal. Our shake had about 1000 calories in it or more. The secret was in the coconut milk that we used. It has 400 cal in 1 cup. Here is the link https://www.amazon.com/gp/aw/d/B00BON7U3M?psc=1. I hope you can get it from Amazon. This is our recepie:
1 or 1/2 cup of the coconut milk
1 cup frozen strawberries
1/2 cup cashews or any nuts
1 banana
1-2 table spoons of honey
Put all in food processor
When all done add 1-2 table spoons of warmed up coconut oil and mix it in with a spoon.
She had this shake every day and when closer to weight restore every other day. We called it a medicine and never told her exactly what was in it. When she asked, we just told her that it had everything for her to get better. First time we gave it to her, we went through hell, but after that it became a little easier. This is true for every new food item. Everything was a battle, but got easier after the initial battle. Until a new food item was introduced. Hang in there. It's not easy, but very possible. We didn't negotiate with our daughter. She knew within the first few weeks or so that the expectation was that everything that we put in front of her must be eaten. Everybody find their own way, but the first step is weight restoration. This forum is great for education!
bewell

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Reply with quote  #15 
As Kali suggested it is good to have a schedule of 3 meals and 2 snacks. Easier for you and will get easier for her to be on a schedule. We used that coconut shake for her afternoon snack.
pettelly

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Reply with quote  #16 
Again thank you and mange tak til Kali 

We did get her to come and eat a small square of chocolate cake. It took over an hour with a lot of tears and anger but she ate it eventually.

Then she sat there, just looking so defeated and dejected it broke my heart. I asked her if she's angry and she said no and then I asked if she's scared and she nodded and then came floods of tears (from just about everyone - her, me, my husband). 

I've booked an appointment online but the first one for non-urgent cases is only on Friday. I'm thinking I might call tomorrow for a same day appointment. I'm beyond myself with worry. 

I'll try to make a smoothie tomorrow for her with what i've got (lactose-free yoghurt, banana, strawberries, peanut butter and avocado plus some seeds).
bewell

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Reply with quote  #17 
If you can find avocado oil you can mix it in the smoothie. It has no flavor at all and adds a ton of calories.
pettelly

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Reply with quote  #18 
What do you do about school lunches? I suspect she'll undereat or skip lunch. I can see what she buys on her card but obviously not if she actually eats it. Her school happens to be only a 10 min cycle from my work so I'm tempted to go there to eat lunch with her on the days that I can (although that might embarrass her completely!)
toothfairy

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Reply with quote  #19 
Hi there, 
A word of advice, do not negotiate over food, AN has taken your D hostage, and it is a bad idea to negotiate. I learnt to be very direct.
"So sorry your eating disorder is making you feel like this" mm now whats on TV  later - distract distract.
Or I do not engage with anorexia. Here is your pizza... Now where is the remote control.

The other thing is, try and remain calm...calm and consistent caring and compassionate but very firm. She is absolutely terrified, and it does not help if parents are crying too, fake it until you make it that  you have "got this " and will get her through.
Read and learn as much as you can, here are some links.

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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
toothfairy

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Reply with quote  #20 
http://www.nytimes.com/2006/11/26/magazine/26anorexia.html?mcubz=3


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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
toothfairy

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Reply with quote  #21 
http://www.nytimes.com/2006/11/26/magazine/26anorexia.html?mcubz=3
__________________
Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
toothfairy

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Reply with quote  #22 

__________________
Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
Kali

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Reply with quote  #23 
Hi Pettelly,

De var så lidt!

If you can bicycle over to her school and have lunch with her that would be great! She may not be able to take enough lunch on her own, as you have already figured out by taking a look at her lunch card. The more meals which she can eat with you and other family support persons, the better. 

Kali

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toothfairy

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Reply with quote  #24 

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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
toothfairy

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Reply with quote  #25 

__________________
Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
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