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smileymum

Hi all
Would love some ideas/input from you great people if you can. Already have learned so much from this site. Excuse long post but want to keep learning from those that have been there...

Quick outline: D is 17 y/o out of IP and W/R 4 months. Compliant with me plating 6 meals a day and eating choc, fats, carbs etc although restrictive in terms of meal variety. Beacuse of great advice on this forum, I upped calories over the last month to take her over weight target. It could be a co-incidence but in the last 2 weeks she has spontaneously started experimenting with different foods which could be related to her higher weight. Hope you don't mind if I bullet point these questions and would really appreciate some ideas:

1. She says she never feels hungry.  (i know not to rely on h.cues and she has to eat regardless) is this normal?  Counsellor suggested we might experiment with losing a snack or reducing snack volume as this might increase appetite for dinners and make 'fear foods' easier as some hunger would be there. She likes sugar though and might spontaneosuly eat sweets if they are around or ask for an ice-lolly after dinner or between meals.

2. We were on the rugby field yesterday during some cold, rainy weather. She was wrapped up but I noticed she was the only girl shivering with the cold. She is absolutely  W/R, as said, recently above target and has a regular good intake of oils and fats and sugar. Related to anorexia do you think, or just one of those things?

3. She needs regular food, granted,  but we had a breakthrough in terms of introducing new foods in the 1/2 term with more social stuff and off-the-cuff eating and 'just grabbing something out' to eat on our way to places. Food was regular but sometimes later, earlier than usual. She seemed to respond well to spontaneous eating. For example, we met family at a ice-cream parlour. The goal was just to see family and there was no pressure on her to eat anything  - they all know her condition and she was welcome to just have a coffee. She said she'd have a scoop of ice-cream and I said: that's fine but we'd need to still have a little something later to make up the energy. She said: I'll have 2 scoops then (small smile like she really wanted it.) I said: cone or bowl? She said: cone. Also, took her shopping and we had to grab something to eat in the car on our way somewhere else. She opted for pasta pot (and she hasn't had pasta for 3 months.) At home she doesn't want to know about any meal plan or what food is coming. As I mentioned in another thread, in contrast to most, she gets bored and feels constrained by the same old, same old, I think.  I know most kids don't seem to like a change of routine, but she seems to respond better to stimulation, new places and situations. She is 17 and so maybe this is why? Just wondering if people here have had breakthroughs in eating by changing things up, being spontaneous, eating off the cuff, 'shall we just get a xxxx out? It seems so much different than the typical. Is it a good idea to not be so rigid with our 6 meals a day and play around with 4 or 5 meals a day (as long as she eats every 4 hours) Counsellor said we could experiment a bit using a feedback not failure line but I'm nervous of disrupting a routine that has served us well so far. There are still ED cognitions, I am not sure she would eat if I wasn't around and of course, more variety is still needed though we are making slow headway here.

4. She wants to be a vegetarian. I know the risks and I've said no for now and  I've told her that we are aiming for no restriction and that ED can use it as an excuse to not eat/eat less even if her motives are pure now. However, long before ED, she never especially liked meat, loved animals and adores them now (can watch a horror film without flinching but if an animal is threatened in it, she gets distressed) We are also working on her having more autonomy in life as she has been ill and out of life with CFS/anxiety for much of it. So, trying to balance this I've introduced vegetarian foods and have got over some fear foods this way  - but we are still keeping on with the meat. I've said: if you can eat a range of veggie and meat options, that means there will always be something on a menu you can eat. It might mean you can then reduce your meat consumption overall in the future as you have a variety of great alternatives but variety is key and meat needs to be part of your life for some time. I hope I haven't opened a door to later restriction but with her age and psychiatric history (Pre ED physically poor health, suicidality, s/h,anxiety)  it didn't feel right to close her down completely. Has anyone successfully accepted vegetarianism and seen s or d recover fully?

Thanks so much in advance for any insight, thoughts.....xx

Smileymum
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Torie

1. She says she never feels hungry.  (i know not to rely on h.cues and she has to eat regardless) is this normal?  Counsellor suggested we might experiment with losing a snack or reducing snack volume as this might increase appetite for dinners and make 'fear foods' easier as some hunger would be there. She likes sugar though and might spontaneosuly eat sweets if they are around or ask for an ice-lolly after dinner or between meals.

Oh good grief no, I would not be cutting back snack at this point!  That is a risk I would not not not want to take.  It is fine and normal for her to lack hunger cues at this point.  One good way to establish hunger cues is to feed at the same time every day.  Then her body will be surprised if the meal snack is a bit late.

2. We were on the rugby field yesterday during some cold, rainy weather. She was wrapped up but I noticed she was the only girl shivering with the cold. She is absolutely  W/R, as said, recently above target and has a regular good intake of oils and fats and sugar. Related to anorexia do you think, or just one of those things?

Dunno.  Sorry.

3. She needs regular food, granted,  but we had a breakthrough in terms of introducing new foods in the 1/2 term with more social stuff and off-the-cuff eating and 'just grabbing something out' to eat on our way to places. Food was regular but sometimes later, earlier than usual. She seemed to respond well to spontaneous eating. For example, we met family at a ice-cream parlour. The goal was just to see family and there was no pressure on her to eat anything  - they all know her condition and she was welcome to just have a coffee. She said she'd have a scoop of ice-cream and I said: that's fine but we'd need to still have a little something later to make up the energy. She said: I'll have 2 scoops then (small smile like she really wanted it.) I said: cone or bowl? She said: cone. Also, took her shopping and we had to grab something to eat in the car on our way somewhere else. She opted for pasta pot (and she hasn't had pasta for 3 months.) At home she doesn't want to know about any meal plan or what food is coming. As I mentioned in another thread, in contrast to most, she gets bored and feels constrained by the same old, same old, I think.  I know most kids don't seem to like a change of routine, but she seems to respond better to stimulation, new places and situations. She is 17 and so maybe this is why? Just wondering if people here have had breakthroughs in eating by changing things up, being spontaneous, eating off the cuff, 'shall we just get a xxxx out? It seems so much different than the typical. Is it a good idea to not be so rigid with our 6 meals a day and play around with 4 or 5 meals a day (as long as she eats every 4 hours) Counsellor said we could experiment a bit using a feedback not failure line but I'm nervous of disrupting a routine that has served us well so far. There are still ED cognitions, I am not sure she would eat if I wasn't around and of course, more variety is still needed though we are making slow headway here.

Personally, I would not be willing to undertake this experiment as it feels like playing with fire to me.  New places and situations - fine and good.  Messing with six meal structure - not so much.

4. She wants to be a vegetarian. I know the risks and I've said no for now and  I've told her that we are aiming for no restriction and that ED can use it as an excuse to not eat/eat less even if her motives are pure now. However, long before ED, she never especially liked meat, loved animals and adores them now (can watch a horror film without flinching but if an animal is threatened in it, she gets distressed) We are also working on her having more autonomy in life as she has been ill and out of life with CFS/anxiety for much of it. So, trying to balance this I've introduced vegetarian foods and have got over some fear foods this way  - but we are still keeping on with the meat. I've said: if you can eat a range of veggie and meat options, that means there will always be something on a menu you can eat. It might mean you can then reduce your meat consumption overall in the future as you have a variety of great alternatives but variety is key and meat needs to be part of your life for some time. I hope I haven't opened a door to later restriction but with her age and psychiatric history (Pre ED physically poor health, suicidality, s/h,anxiety)  it didn't feel right to close her down completely. Has anyone successfully accepted vegetarianism and seen s or d recover fully?

My d summed up my feeling about this really well when I overheard her say, "I think my mom would have a heart attack if I suggested becoming vegetarian."   You can buy free range eggs and organic beef etc. to help her concerns about the animals.  Others will have ideas, too, about for example explaining that vegetarianism hurts animals too.

I tend to be very cautious and s-l-o-o-o-w in letting go of the reins with ED because of all the horrifying stories of relapse I have read here.  In my own risk/benefit analysis, the risk side is a very heavy weight and the benefits, not so substantial.

This is all just my opinion of course and worth exactly what you paid for it.

It sounds like your d has made tremendous progress!  I'm so proud of how far you guys have come already. xx

-Torie

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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smileymum
Hi Torie and Toothfairy
thanks so much for your input and with your vast experience, I will take it all on board.

Going to stick with 6 meals a day, take on specific veggie foods but allow no meat restriction for the foreseable or kick vegetarianism into long grass anyway, and not worry about hunger cues or look to alter our timings to increase hunger....

Really appreciate you wading through my tome. Good to have back-up. Thanks. All power to you and yours. xxx
Smileymum
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tina72
Hi smilemum,

just chiming in to say the same as the others [wink].
Did she have hunger cues before ED? We just recently noticed that our d never said she is hungry before when she was a child. She always ate with appetite but I think just becuase it was meal time...

The vegetarian thing:
We had long discussions about that. Now we are flexitarian. That means we eat fish 2x, biological raised meat 2x and 3x vegetarian each week.
We decided that biological raised meat is o.k. to eat because a) it helps the farmers to do this system and eliminates the old system by time in which the animals suffered and b) we decided that animal have a right to live, too and those chickens we eat now from the biological farm would not be born if we would not buy them. So now they have at least a wonderful year living there.
Biggest argument was that for vegetaria food you need a lot of soya and soya production destroys rainforest and the living of MANY animals, so being vegetarian DOES NOT SAFE ANIMALS. Even if you would eat only salat you will destroy the living space of small insects with this. It is not possible to live without killing ANY animals, we just can decide how much.

Keep feeding. There is light at the end of the tunnel.
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Mamaroo

smileymum wrote:

1. She says she never feels hungry.  (i know not to rely on h.cues and she has to eat regardless) is this normal?  Counsellor suggested we might experiment with losing a snack or reducing snack volume as this might increase appetite for dinners and make 'fear foods' easier as some hunger would be there. She likes sugar though and might spontaneosuly eat sweets if they are around or ask for an ice-lolly after dinner or between meals.

This sounds very logical, doesn't it? Our GP suggested the same, but the reality is that those who are recovering from AN have high metabolisms and require a lot of food, regardless if they feel hungry. When my d was allowed to choose her own snacks, her period disappeared for 2 months. I had to take control again and increase her snacks and am still doing it.

smileymum wrote:

2. We were on the rugby field yesterday during some cold, rainy weather. She was wrapped up but I noticed she was the only girl shivering with the cold. She is absolutely  W/R, as said, recently above target and has a regular good intake of oils and fats and sugar. Related to anorexia do you think, or just one of those things?

In my opinion, yes, it is related. More food intake will result in a higher metabolism, which will keep her warmer. In addition if her total body fat is increased it will keep her warm as well. My d eats so much more than we do, yet she still is the skinniest of us all. She also is the first to feel hot. It would frustrate me that she would go out without a sweater and with shorts during the winter. 

smileymum wrote:

3. She needs regular food, granted,  but we had a breakthrough in terms of introducing new foods in the 1/2 term with more social stuff and off-the-cuff eating and 'just grabbing something out' to eat on our way to places. Food was regular but sometimes later, earlier than usual. She seemed to respond well to spontaneous eating. For example, we met family at a ice-cream parlour. The goal was just to see family and there was no pressure on her to eat anything  - they all know her condition and she was welcome to just have a coffee. She said she'd have a scoop of ice-cream and I said: that's fine but we'd need to still have a little something later to make up the energy. She said: I'll have 2 scoops then (small smile like she really wanted it.) I said: cone or bowl? She said: cone. Also, took her shopping and we had to grab something to eat in the car on our way somewhere else. She opted for pasta pot (and she hasn't had pasta for 3 months.) At home she doesn't want to know about any meal plan or what food is coming. As I mentioned in another thread, in contrast to most, she gets bored and feels constrained by the same old, same old, I think.  I know most kids don't seem to like a change of routine, but she seems to respond better to stimulation, new places and situations. She is 17 and so maybe this is why? Just wondering if people here have had breakthroughs in eating by changing things up, being spontaneous, eating off the cuff, 'shall we just get a xxxx out? It seems so much different than the typical. Is it a good idea to not be so rigid with our 6 meals a day and play around with 4 or 5 meals a day (as long as she eats every 4 hours) Counsellor said we could experiment a bit using a feedback not failure line but I'm nervous of disrupting a routine that has served us well so far. There are still ED cognitions, I am not sure she would eat if I wasn't around and of course, more variety is still needed though we are making slow headway here.

If your d is WR and has few fear food, I think it is a good time to change things and eat more spontanously now and again. We stick with 3 meals and 3 snacks during the week, but over the weekends, breakfast and morning tea are combined so that she can sleep later. When eating out or with friends more flexibility is allowed. Just keep track in the back of your mind that she is still having enough during the day.

smileymum wrote:

4. She wants to be a vegetarian. I know the risks and I've said no for now and  I've told her that we are aiming for no restriction and that ED can use it as an excuse to not eat/eat less even if her motives are pure now. However, long before ED, she never especially liked meat, loved animals and adores them now (can watch a horror film without flinching but if an animal is threatened in it, she gets distressed) We are also working on her having more autonomy in life as she has been ill and out of life with CFS/anxiety for much of it. So, trying to balance this I've introduced vegetarian foods and have got over some fear foods this way  - but we are still keeping on with the meat. I've said: if you can eat a range of veggie and meat options, that means there will always be something on a menu you can eat. It might mean you can then reduce your meat consumption overall in the future as you have a variety of great alternatives but variety is key and meat needs to be part of your life for some time. I hope I haven't opened a door to later restriction but with her age and psychiatric history (Pre ED physically poor health, suicidality, s/h,anxiety)  it didn't feel right to close her down completely. Has anyone successfully accepted vegetarianism and seen s or d recover fully?

I told my d that one cannot put petrol in a plane and expect it to fly. The same applies to her, she won't be able to extract all the nutrients from a vegetarian diet. Her body is just not made that way. She also loves animals and wants to become a vet. I am like your d, I can't watch a movie where animals are hurt and I refuse to watch any movie where I know the dog dies. But, like Tina said, even insects are killed when vegetables are grown. I grow fruit and veggies in my garden and it is impossible to have any fruit/veggies without some bug trying to eat it. If I used no pesticides I would have no harvest. 


D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Torie
I would like to add a few general comments.  In the 4 1/2 years I have been here, I can't think of anyone who has said, "I wish we had gone faster."  Time and time again, we have seen people dragged back down the rabbit hole by trying to rush things.  So in the Torie household, we took things extremely slowly.  

The standard advice here is: Three meals and 2-3 snacks.  I think your d is on the 3-snack plan.  Would it be okay for her to switch to the 2-snack plan?  In a way, probably yes.  And eventually the answer will certainly be yes. So why did I respond so strongly with a "no"?  Because it sounds like you are being pushed into that.  

I can't think of a forum member who has needed or benefited from such a push. It makes the hair on the back of my neck rise when I read the suggestions you report - it feels like they are trying to push the timeline ahead.  (Editing to say,  very occasionally there is a legitimate reason to push the timeline in spite of the increased risk, but I'm not seeing any compelling circumstances here.)

It is nice if they regain their hunger cues, but not all do, and hunger cues are not essential.  What IS essential is getting her to - and keeping her at - a proper weight, for a very long time.  That is practically the only thing that matters.  I can't remember your timeline too well, but I think your d is still in a fragile stage of recovery.  If that is the case, I urge you to keep your eye on the ball and make sure you protect her intake every. single. day.  That is your first, second, and third priority.

You will have all the time in the world to worry about flexible schedules later.  You will know when that time has come.

Keep swimming. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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smileymum
Tina, Mumaroo and Torie

Thanks for your thoughtful posts. Based on what you've said and kind of my own gut, I'm not going to rush things. She doesn't feel stable in recovery but she is compliant with regular eating (although not eating a super-wide range yet), me coming to college to eat with her in the car etc. She is also slowly coming off olanzapine and I have been reading that it is often at the last low dosage where anxiety can rear up again. So, on reflection, it would be crazy to jeopardise this stability and mess about with her established eating pattern. The other thing is, from a toddler she grazed and ate regularly and struggled with single sittings of big portions. Hence,  6 x food through the day rather than 3 bigger servings, for example, suits her in terms of getting enough calories in.

In fairness CAMHS suggested these options but didn't push it, leaving it up to me to decide whether to 'experiment.' They also suggested we might encourage her to make her own packed lunch, with me supervising without pushing her into it.  I asked her but she didn't want to so I didn't push. She makes her own porridge in the morning with supervision but that's it.

There is no real hurry but I suppose since she has turned 17 at the back of my mind I was thinking: can we move through this before she is in adult services? However, I know nothing magical happens at 18. It is just a number - plus she is just re-taking her 1st college year so she will be at home for 2 years before uni. 

She's busy and enagaged in life which is amazing so soon out of IP, despite tremendous anxiety, but food is always supervised except for 1 lunch a week which she eats with friends. She does well eating socially but we aren't rushing into any more unsupervised eating for now. 

The vegetarian thing - kicked into long grass and I'll continue to  introduce both veggie and meat options. Wish she did like fish but she never has. If she brings it up again, I'll encourage her to find other ways we can be kind to animals in the way you have suggested mamaroo and Tina72. Very helpful. The balance for us, because of very little autonomy she has had in life so far,  is not to dismiss her suggestions out of hand. At the same time, she knows I'm in charge of food and I think at some level this must give her reassurance.

So, I just want to thank you all for listening to my stream of conciousness. You've helped me make up my mind that the only thing I'm going to push/change up for now is to introduce more fear foods. Ice-cream and choc cake last night. Hurrah.

Thanks so much. I wonder how many lives you have all impacted by your insight and experience? 
Keep on. xxx
Smileymum
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tina72
" Ice-cream and choc cake last night. Hurrah."

Yeah!!! You are doing great! So happy for you! [thumb]
Keep feeding. There is light at the end of the tunnel.
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