F.E.A.S.T's Around The Dinner Table forum

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Lexi123
Hi everyone,

it was suggested to me to start a topic as I have some questions on this. My D struggles with purging, usually following a full meal. She will occasionally binge on foods she restricts and then purge, so I try to encourage her to eat those foods more often to prevent bingeing and purging, but it is so hard for her. Yesterday I made her a meal on her “no” list (pasta with veggie meatballs and sauce with plenty of oil and added fats as she need to gain at least 10 pounds), and she ate it without complaint, but purged straight away after. She shared she had an abnormal EKG, her liver enzymes are suffering, and her heart rate was very low at her last appt. That plus the low weight really are concerning me. She’s with me for the next week and I would love some tips on how to help feed her and not let her purge (through vomiting as well as a exercise). Thank you!!
D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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ValentinaGermania
No bathroom privacy at all. You could send her to the toilet before meals. If she vomits at the table directly after the meals, you could wait for about an hour and then serve another meal to replace it. Make clear that all food that has been lost by vomiting must be replaced from her money. Make sure that all food that is vomited must be replaced in the next meals.
Exercise: You could supervise her 24/7. Tell her that any exercise must be replaced with more food at the next meal. You could sleep with her if needed to avoid secret exercise in the nights.
Keep feeding. There is light at the end of the tunnel.
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Enn
I am quite concerned about the EKG and heart rate and the liver  issues. Does your d have medical support?
That would be my first priority. 
Regular mealtimes may help her so she does not get too hungry to binge.
No closed doors in the bathroom and supervision for at least one hour after eating. Talking /singing in the bathroom so that you know if she is purging.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Enn
Here is a good video
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Foodsupport_AUS
Lexi123 just trying to clarify here. In your previous posts you have mentioned that your D is living independently with her boyfriend, but this post is suggesting to me that she is living with you?

Stopping purging is difficult, there is reported to be an addictive component to it so once started it can be very difficult to stop. The chemicals released when purging can mean that people deliberately binge in order to purge rather than the other way around. Enn has also highlighted the serious physical risks associated. 

Supervision is one way to stop purging. Regular meal times can reduce bingeing. 

If her EKG is abnormal this is a sign that she is at high medical risk, and any further purging can worsen this. (Without trying to frighten you, sudden death from cardiac changes is a risk with purging). It sounds like she may need hospitalisation rather than managing this in the home environment. Is her boyfriend aware of her medical risk? Can you work as a team to move her towards more intensive treatment?
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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Lexi123
No bathroom privacy at all. You could send her to the toilet before meals. If she vomits at the table directly after the meals, you could wait for about an hour and then serve another meal to replace it. Make clear that all food that has been lost by vomiting must be replaced from her money. Make sure that all food that is vomited must be replaced in the next meals.
Exercise: You could supervise her 24/7. Tell her that any exercise must be replaced with more food at the next meal. You could sleep with her if needed to avoid secret exercise in the nights.


this is all really helpful! Unfortunately she doesn’t live with me and is only visiting,  it I will implement those things when she is in my home. Thank you. 
D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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Lexi123
Enn wrote:
I am quite concerned about the EKG and heart rate and the liver  issues. Does your d have medical support?
That would be my first priority. 
Regular mealtimes may help her so she does not get too hungry to binge.
No closed doors in the bathroom and supervision for at least one hour after eating. Talking /singing in the bathroom so that you know if she is purging.


thank you. The medical aspect is worrisome. She is being medically monitored, but not as often as I’d like. 
D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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Lexi123
Lexi123 just trying to clarify here. In your previous posts you have mentioned that your D is living independently with her boyfriend, but this post is suggesting to me that she is living with you?

Stopping purging is difficult, there is reported to be an addictive component to it so once started it can be very difficult to stop. The chemicals released when purging can mean that people deliberately binge in order to purge rather than the other way around. Enn has also highlighted the serious physical risks associated. 

Supervision is one way to stop purging. Regular meal times can reduce bingeing. 

If her EKG is abnormal this is a sign that she is at high medical risk, and any further purging can worsen this. (Without trying to frighten you, sudden death from cardiac changes is a risk with purging). It sounds like she may need hospitalisation rather than managing this in the home environment. Is her boyfriend aware of her medical risk? Can you work as a team to move her towards more intensive treatment?


hi, she does not live with me but lives with her boyfriend. She has been visiting since she took a few days off of work for Christmas. I don’t think her boyfriend is aware of all the medical issues she’s experienced. I do think I need to have a conversation with him to help him help her stop purging. I know in the past he’s helped her by talking to her through the bathroom door if she’s in there, etc. Agreed about the medical aspect here. I know she is going back to the dr on Tuesday for a repeat EKG and bloodwork. I really want her to do a more intensive treatment. As always, thank you for your support. 
D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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ValentinaGermania
Can you get her boyfriend into the boat and offer leverage for every time he gets her to see a doctor?
Keep feeding. There is light at the end of the tunnel.
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Francie
How is it going, Lexi? 

Francie

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Lexi123
Hi Francie,

thanks for checking in. Things have been rocky. She’s been able to decrease her purging and had a repeat EKG which showed the same issue as before. Her doctor says it will go away with weight restoration. I’m trying to convince her to take a medical leave to go to residential. I’m going to make a new post about this... she does not want to leave her job. If she does not make changes, she will eventually not be able to work at all, but she doesn’t see it like that.
D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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Francie
hi Lexi, I am glad your d has been able to decrease her purging. May I ask how that happened? Her EKG is stil abnormal, and liver enzymes elevated. Do you know what is the connection between liver enzymes and ED? My d just had blood work that also showed elevated liver enzymes. Doc says my d is either drinking or abusing Tylenol but I don't think that is true. I think it is related to ED but I'm not sure how or why. I think your d is not with you and has gone back to her home with her boyfriend now, is that right?

Francie

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Lexi123
Francie,

from what her doctor has explained, the elevated liver enzymes is from purging because the liver begins to break down the food and then it is forcibly removed through purging. It’s very common with purging. I can’t exactly remember what her doctor said but can ask her again and get back to you. She decreased her purging because she was concerned about the elevated liver enzymes. Unfortunately this means she has been restricting more. I can’t tell what’s worse. She is back with her boyfriend so not with me, you’re right. I’ve been trying to see her more to provide support since she doesn’t live far from me. How often is your d purging?
D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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ValentinaGermania
Lexi123 wrote:
Hi Francie,

thanks for checking in. Things have been rocky. She’s been able to decrease her purging and had a repeat EKG which showed the same issue as before. Her doctor says it will go away with weight restoration. I’m trying to convince her to take a medical leave to go to residential. I’m going to make a new post about this... she does not want to leave her job. If she does not make changes, she will eventually not be able to work at all, but she doesn’t see it like that.


Maybe it is needed to have a serious talk with her boss. I can imagine that it is not in his interest that she collapses at work. So maybe if he tells her to take that medical leave or lose her work she will go. Sometimes we need to do hard things but it is what is needed. As you say, she might not be able to work at all...
Keep feeding. There is light at the end of the tunnel.
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Francie
Hi Lexi, I am glad your daughter is purging less. I hope that is not accompanied by more restriction. How does your daughter feel about taking the steps to recovery? My d is lukewarm, does some of the work, does not do all of the work. My daughter is trying to get her purging down to 4X a week. That may sound alarming, but if she achieves this it will be progress because purging is daily at times! We recently reinstituted a 'wait 1 hour after eating before using the bathroom' rule. She was compliant in the morning yesterday, but non-compliant in the evening. I am monitoring her to see if I can figure out why she makes the choice to be compliant or to be non-compliant.

Francie

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ValentinaGermania
Francie, I just thought wether you might help your d to reach that goal by offering an incentive if she gets to "only" 4 times? Something she is really keen on and might find more important than ED?
Keep feeding. There is light at the end of the tunnel.
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Francie
My daughter knows she will get a car if she can be symptom free for a few months. Re: shorter term awards, she earns car privileges for days she is symptom-free. Purging is costly for her: she pays for missed therapy appointments and food she purges. She gains independence on days she is symptom free, but has to be driven places or has to hire an Uber or take public transportation on days she purges as she is not healthy enough to safely drive.

She very much wants to live an independent life but her purging is costing her a lot of money and independence, which she desperately wants. IF she continues this way she will not be able to afford to live on her own unless she can be rid of her purging habit and is healthy. Her ED has caused her to rack up a credit card debt that she is trying to pay off first. In addition to the credit card debt, she owes her dad and me money for damage to the car and college courses she has had to drop due to ED symptom and drug use.

Francie

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Lexi123

Hi Francie:

Sounds like you have a strong plan in place to help your d. Purging is so dangerous and she cannot be safe if she is purging. My d is unfortunately restricting more, but she doesn’t really share so much with me. I tend to go based on how she’s acting/conversations with her boyfriend. Any advice on what to tell her about taking a medical leave? She’s worried she will lose her job if she does. 

Tina:

Thanks for your input. I worry about talking to her boss without her permission. She is an adult and ideally will make the right decision. I’m trying to continue encouraging her to go to treatment. 

D is 23 with restrictive anorexia since age 13. Purging tendencies shortly there after. Currently underweight and struggling with restricting as well as purging. 
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ValentinaGermania
Here the car worked well as incentive but to be honest we had no purging.
Maybe the car is a too far away incentive. Could you offer her using your car for every day she does not purge?
Keep feeding. There is light at the end of the tunnel.
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Francie
Hi Lexi, What to tell your daughter about taking a medical leave - does your daughter know where her employer stands on medical leave of absence? Maybe the first place to start would be to ask your daughter whether her fears about losing her job are real and based on fact, or are they just her fear that she is not valuable enough at her company to be granted a leave. And then listen to what she says without pushing your agenda.

Maybe her employer would be agreeable to her taking a leave. She won't know unless she asks. And when you talk with her, I am sure you know about using "I' statements, and talk about how you feel as in "I feel sad to see you struggling. I am wondering how you would feel about getting treatment for yourself, to get you in a stronger place.". The following link was shared with me by another FEAST member, and it has been helpful in forming helpful communications with my d: http://thenewmaudsleyapproach.co.uk/index.php/test-page-1/test-sub-page/

Maybe her boyfriend has an opinion about her taking a leave of absence. Do you know? Maybe he can be helpful in having the conversation with your daughter. Maybe he has observations about how your daughter's health is impacting their lives together.

My d has a part time retail job and her employer allowed her to take 2 months off for treatment. She was not paid, though. We encouraged our daughter to talk to her boss to request time for treatment. She didn't want to. She was afraid to ask and she was afraid to tell him the truth about why she wanted the medical leave. But when she missed three consecutive days of work due to her ED, and was so ashamed about it she couldn't even call out sick, she did find the courage to call her boss to explain her situation. Her boss was very sympathetic and understanding of what she needed to do and allowed the leave. Our daughter knew she had our support to take a leave of absence for treatment, but ultimately it was her own realization of how her illness was impacting her work and life which gave her the courage to ask for a leave of absence. She realized that if she kept up her symptom use to the degree she had, she would lose her job! 

I wish you the best of luck! Keep me posted. XO

Valentina: Thank you for your input. I did mention in my last posting that our daughter gets the car on days she doesn't purge. I may have worded it in an indirect way, above.

Francie

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