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

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kloos Show full post »
kloos
Hi sk8r31, thanks for the welcome.  Everyone is so nice here.  I've only been here for 5 hours and already feel a part of a close nit community.  My current plan of action is to sit down with her tonight to discuss it (if she's in).  We will start taking blood pressure and heart rate (we have a machine).  I will start insisting that she splits her plate into 1/3rds for meals, let's start with the evening meal and build up.  I want to see what she is eating.  

Tina, Her periods have not stopped this time but it is too early to tell as we only noticed the re-lapse 3 weeks ago. 
btw the pic isn't that close to what i look like lol.
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scaredmom
Kloos,
Just wish to ask, will she be seen by a specialist ED clinic? Was this the same as last time? 
i also wish to tell you that there are many roads to Rome. 
Some of us have pushed our kids and become very strong in our approaches and unbending. Some of us have used a softer approach. None are  right or wrong. It is what fits you and you child’s style is what is best. We can only tell you our experiences and it is for you to take what makes sense in your situation at any given time.

i do think watching/knowing what she is actually eating will be very telling. If she eats separately from you she is likely less medically stable than you know.
you mention the clinic says she is drinking ok so they are not worried. Which clinic is that if you are waiting for another clinic for assessment? 
when taking orthostatic BP and heart rate 
if the difference after 5 minutes systolic greater than 20 mm Hg drop from lying to standing and an increase or heat rate more than 10  in the difference, that is concerning.
A life threatening complication that is not heart related is hypoglycaemia. Or low blood sugar. Ensure she is eating sugars anyway you can do it. Easier said than done I know.

I am glad you are taking her to a doctor soon and don’t be shy if you need to take her to emergency if you worried even before that time.
the marsipan guidelines were posted above for you, It may help to print them out and have them ready for all doctors appointments as well and in case you need to go to the hospital.
Sending my best
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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kloos
we are taking her here: https://healthyyoungmindspennine.nhs.uk.  She did see them last year and it didn't help but apparently she is now seeing a different department.
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tina72
I just want to add that some old rabbits here told me 2 years ago to do EVERYTHING possible to get my d weight restorated and have brain recovery started before she turns 18 and can refuse treatment and close you out. I was glad to listen to that advice, my d was WR 5 months before she turned 18 and 2 months before that date brain recovery started and she was totally compliant about FBT and help with eating on her 18th birthday. It was just in time. Please be aware that this is really an important date with a young adult.

"I will start insisting that she splits her plate into 1/3rds for meals, let's start with the evening meal and build up.  I want to see what she is eating."
The splitting in 1/3 is just a start to make her eat all parts of a meal. For refeeding you might need to change that again. We are going for 1/2 carbs, 1/4 meat/fish and 1/4 vegetables today or we will not get enough calories in.
To see what she is eating is very important, they are great artists in hiding food, do not turn your back while eating. They hide food in napkins, under the plate, in pants pockets or sleeves. In flower vases, boxes, give it to the dog ...and and and. Be creative!
Keep feeding. There is light at the end of the tunnel.
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strawdog
Hi Kloos - reading your story about your d is scarily similar to my experience with my 16 year old d (i'm a Dad)She loved to cook - at first we thought great she's taking an interest in healthy food and cooking - that's great! There's so much out there about unhealthy over weight teenagers we just thought it was 'healthy' - great! But then she joined the gym - just once a week but then by the end of the year 2 or 3 times a week. The control of food got stronger - she had to plan the meals and shop with us and they became healthier and healthier - less and less fat and so on. Luckily she eats with us so we were at least able to monitor meal times but she was not eating much at all at school. She used to do the same as your d - squeezing her rolls of fat on her legs and tummy (that were just normal) and obsessing over her appearance. The trigger for us was Xmas - she went into that OK and actually let herself indulge in chocolates and good food but post Xmas she went downhill - thinking she had over done it and her obsessions became worse. We started thinking there were real problems and people we commenting that she was getting too thin. The big thing for us though was that she came to us for help - she was fed up with feeling the way she was feeling - the ED voices in her head had got too much. We went to the GP and luckily within a couple of weeks we were at CAMHs and on the re-feeding plan. All the things she had to stopped - cooking, shopping, exercise - she went cold turkey, It was hell I'm afraid but like you I don't think she would have started before the CAMHs meeting and the diagnosis and being told she had to do it. The good thing for you is you've come on here - it's a life saver! These people really know their stuff and you are getting and will continue to get great advice. Hope she keeps safe until the appointment and good luck!
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kloos
Thanks to all of your advice we had a long chat tonight.  Her blood pressure and pulse are fine, but her bmi is slightly too low.  After a lot of tears, she agreed to have a small potato with her evening meal of quinoa, chicken and veg.  She is now back on the slimming world diet which involves a healthy meal and also encourages 1/3ds for each meal.  She is actually looking forward to porridge for breakfast.  

Not out of the water yet, far from it, but a step in the right direction.  I am monitoring her bp and meals every day at least until the clinic appt in 3 weeks,
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scaredmom
Hi there from what I have seen of slimming world diet, that she wishes to follow, is that is very concerning. (I hope I understood your post above properly. )
It is low fat and most here could not get the calories up for our kids to gain weight without fats. Otherwise if having  a low fat meal one would have to eat large volumes to gain weight. It is easier for ED to eat a smaller volume of high quality foods (a smaller ‘food print’’) than 5
large steaks to get the calories /nutrition required, for example.
Many have found in order to get our kids better we did have to change our minds about what a healthy diet was. In order to get weight  on, I did and still do need to feed my d high calories high fat foods that others may feel are ‘unhealthy’
My views have changed radically and the only ‘bad’ or unhealthy foods for me are poisonous or rotten.
I am glad you spoke with her.
All the best
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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tina72
"She is now back on the slimming world diet which involves a healthy meal and also encourages 1/3ds for each meal.  She is actually looking forward to porridge for breakfast."

Same concernes as Scaredmom, ANY diet is wrong at the moment, normal meals, normal food, 30% fat in intake is crucial.
No diet for a growing and developing child at all. No diet for an AN patient at all. Stop that.

Serve the porrige, put some fullfat milk and some cream in it and make sure it is a normal portion size.
Keep feeding. There is light at the end of the tunnel.
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kloos
I totally understand what you are saying about the slimming world diet.  I see it as a half way house.  We are attempting to heal her body and the specialists will heal her mind (obviously with our input as well).  This is a compromise that we are happy to make at the moment.  d really does like her food and enjoys eating, it's just that the voice keeps guilt tripping her.  If we can break the cycle of not eating properly then she will hopefully start to eat normal food again.  That is what happened last year.  What we didn't do last year was heal the mind which is why it came back.

We are continuing to monitor her weight, she is weighing herself twice a week (she wants to do it every day).  I am monitoring her bp and pulse.  If anything drops then she knows that she will have to up her fat intake. 

Can anyone advise on a recipe book for recovering ED?  Mum and d are very interested in reading that to get ideas for meals.
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tina72
"We are attempting to heal her body and the specialists will heal her mind (obviously with our input as well)."

The malnurished brain is the cause for her behaviour and for that voice. I also hoped that a therapy would help with that but looking back the only therapy needed was good nutrition. The problem last year was not that she did not have enough therapy but that she did not eat normal food and enough food and be on a good weight long enough I suppose. It is crucial that she eats normal food as soon as poosible.

Read Carrie Arnolds book "Decoding Anorexia" asap to understand the biochemical process in her brain. That helped me a lot to understand that.

No weighing herself and not twice a week. They all want to check the weight all the time, my d did it every hour in the end. Get the scale locked away, you put it out once a week and she gets on the scale in underwear under your eyes (best is doing that blind, that means backwards on the scale and she does not see her weight at all, then she can relax about it again). Best is doing it with same scale same day same time. Be aware that some prepare weights in their underwear so be careful il she always wears the same for weighings. Be aware that some do water loading (drinking up to 1 l to have 1 kg more) before weighings so in that case weighings by surprise are better. The target is 500-1000 g weight gain each week. You will not get there on that diet. You do not need a diet that makes her lose weight, you need a diet to gain 🙂.

There are a lot of recipes here, use the search button and words like "high calorie" or "recipes" for ideas.
Normally you can cook what a normal family would cook. Just cook it like your grandma after WW2 would have done with lots of butter, creme and oil. 🙂 And increase portion sizes to normal portions a healty young woman would eat.
Keep feeding. There is light at the end of the tunnel.
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tina72
"but her bmi is slightly too low"

BMI alone says nothing. State, not weight. You cannot expect her to be healthy again when she is on a BMI that is just normal but still on bottom line.
She might need to gain much more than you expect now to be healthy again. I think she was not recovered last year because she did not get to a healthy weight to start brain recovery then.

First the body needs to heal, then the brain recovery starts and then her mind gets better. That is the way it works. Full nutrition is the start of all.
Keep feeding. There is light at the end of the tunnel.
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tina72
https://www.aroundthedinnertable.org/post/feast-recipe-book-call-for-recipes-9915329?pid=1308742606

https://www.aroundthedinnertable.org/post/high-calorie-suggestions-696425?pid=1278198316&highlight=high+caloric
Keep feeding. There is light at the end of the tunnel.
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kloos
Thanks tina.  I will talk to her tonight about the scales.  We might be able to use that as a tool to make sure she puts on.  As in if she doesn't then she looses the scales.  I think it's a very good idea to have my wife oversee the weighing so we will do that.

Her BMI is currently 18.3 which is technically classed a low but ok.  The NHS actually says "your child has a healthy weight" in the 14th centile (not that we believe that).  So we are not panicking about having to put weight on quickly.  I appreciate what you are saying about 1kg gain per week but we are lucky that we have the time to slowly make the change and that is what we are trying to do.  We don't want to fight against d but we want her on our side.  Don't get me wrong, there were tears last night when I told her that she was going to eat a small potato with the meal that she had already prepared.  But she did.  Thanks to your advice, this is working so far.  d knows that she cannot lose any more.  The next message will be that she needs to put on.  The next message will be that she needs to reach a healthy weight.  One step at a time.
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tina72
18.3 is a low BMI for a 17 year old. And that is not o.k. She will need to get at least to 20/21 or even higher. It depends on what percentile she was the rest of her life before she started to restrict. Do you have a historical growth/weight chart?

To make her gain slow means to lengthen the pain and to lengthen the time until brain recovery can start. If she only needs to gain a few kg (which would be great), why not do that in a few weeks or months and then have her brain recovery start soon? It is evidence based that a quick WR leads to a better outcome. And remember, you HAVE a date in the neck (I do not know if you have that say there), she will get 18 and you MUST geht that weight on quick to have her in best state possible then.

I have seen kids here that gained only 200 g/weekly and so very slow in many months IP stay here and did not get better and when the parents took them home and made them gain faster and get WR they were in recovery within a few months. Gaining slow is lost time for all.

I also did not see the necessity for that 2 years ago.

"We don't want to fight against d but we want her on our side." You cannot bath her without making her wet we say here in Germany.

"Don't get me wrong, there were tears last night when I told her that she was going to eat a small potato with the meal that she had already prepared.  But she did."
That is great that you got her to eat that. It is normal that there are a lot of tears at meals. Accompanied by swearing and throwing plates. 🙂
It is not normal to be in tears about eating a potatoe. That is what you need to change.
Keep feeding. There is light at the end of the tunnel.
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deenl
Hi kloos,

Here is a link to the high calorie meal thread and the high calorie snack thread. What most people find is that each mouthful that our loved ones need to eat is difficult (either in the moment or the mental torture later) so it makes sense to make that mouthful as nutricious as possible. In the beginning, that means calories and fats have absolute priority, followed by protein for repair. 

One of the educational eye opening moments for me was when I read about the Minnesota Semi Starvation Study. This was a war time experiment on healthy conscious objectors who were screened for physical and mental health. They were fed about 75% of what they normally ate and they deveoped SO many AN symptoms. It really brought home to me that a huge proportion of the illness is the biological effect on the brain of malnutrition. The first and foundational step in recovery is nutritional rehabilitation; 3 meals and 2/3 snacks each and every day, enough calories to repair the damage done to all the organs of the body (incl the brain), weight restoration to the proper weight for the patient (based on historical records from at least 2 year before first signs of illness) and time for healing to happen. Negative energy balance is a trap constantly ready to trip our kids.

This is a video on the neurobiology of eating disorders. It is an hour long (I view it at 1.5 speed so it goes quicker). It really is time well spent in trying to understand the illness and provide a foundation for how you will support your daughter. Understanding the illness is a journey but one, I believe, is essential to recovery and a return to a happy and healthy life for our loved ones.

Warm wishes,

D
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, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
  • We cannot control the wind but we can direct the sail.
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kloos
I was slightly embarrassed to be here with a d whose bmi is 18.3 as I know full on ED could be 15 and under.  I am glad that you don't feel that way.  I am hoping to move through the stages to weight gain pretty quickly.  She has her docs apt tomorrow morning and I will be there.  We have an assessment at "healthy minds" in 2 1/2 weeks.  If we can improve things before then, it will be a good first stage.
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tina72
There are a lot of very sick AN patients that are not underweight at all. About 25 % of the patients are not underweight at all and that is very dangerous as the EDs are often overseen then by professionals.
With very bad nutritional intake you can die of AN on a "normal" weight.

"If we can improve things before then, it will be a good first stage."
That is the right attitude! You can improve that!
Keep feeding. There is light at the end of the tunnel.
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kloos
thanks deenl.  I will look at the video later.  She has agreed to have snacks, but at the moment it is healthy snacks such as humus.  I know we can do better than that.  Based on what you and Tina are saying I will have another chat to d tonight and we will work out a plan to improve.  What do you think a realistic target weight should be for a 5ft 17 year old?
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deenl
Anorexia nervosa can strike people of any size. However, I think that you may be underestimating the dangers for your daughter especially if her initial weight was higher. It is the amount of weight lost and the speed of weight loss that is often the danger. And people being people in all their differences, there are very sick
patients who have lost very little weight, they are especially vunerable to any loss at all. We have a saying here 'State, not weight' that really puts the emphasis on the most important sign.

In fact, many people with a higher initial BMI end up sicker that others for the following reasons. Medical professionals do not recognize that they are malnourished because they are still in the average 'healthy' range, social comments on how well they look with initial weight loss reinforce the maladjusted thinking, many people do not realise the urgency because they still look well, weight discrimination in society and the medical field means it takes much longer for them to receive treatment.

This is a great podcast discussing all these dangers.

Warm wishes,

D
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, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
  • We cannot control the wind but we can direct the sail.
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scaredmom
Do you have old weight charts for her? Usually you are trying to get her to her natural percentile for weight. If she was at the 75th percentile then that is what you should aim for at least. 
many have had to go higher to see brain improvement. The one thing that took me awhile to understand was that is not a ‘weight ‘ issue but a brain issue and it is the the weight gain that helps the brain to heal.
Is she over exercising? Or even standing all the time? That may be ED and you may need to curtail that behaviour too.
it takes a lot of calories to fill in the hole and then so much more to keep up and for growth too.
there is so much info on this site.
please look up state vs weight.
i will try to post more info later, as time permits.
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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kloos
I didn't fully appreciate that the brain is an organ that needs healing in the same way as other organs.  That is a fascinating concept that I will defo take on board.  The "state not weight" is brilliant (I will search for it in a bit).  I feel that this will be the new mantra in our house from today.  I will report back after my chat with d tonight.
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scaredmom
https://www.aroundthedinnertable.org/post/old-posts-on-state-not-weight-bmi-8473905?highlight=state+weight&pid=1295370438

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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scaredmom

You noted above about not wishing to fight with d. As we challenge the ED it is common for many kids to fight it. We had throwing and screaming here with meals. 
I just wish you to be forewarned, as my team did not prepare me for that, that the can happen. I learned here to use plastic utensils and paper plates just in case.
Also you. are not fighting D you are fighting for D. And sometimes to get them to eat, it may be a fight. It is not easy for sure. unfortunately, saying "please eat this" may not work. She or her ED will not agree to it and just eat. It it were that way, our kids would eat and gain in weeks. 

I had to change how I parented or at least had to become more forceful about eating for sure. The food is her medicine, her chemo, if you will. And she will need her medicine to get through this. All of it. 
It takes time to figure out how to get our kids to eat. It is not as simple as just giving food and they eat. But the goal is to make not eating so unpleasant that the only thing they can do is eat at that moment. 
Many of us had to use incentives, like no phone until you eat, no going out until you eat, no games until you eat. We all find out how that works for our kids. 
You will get there, 

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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tina72
kloos wrote:
thanks deenl.  I will look at the video later.  She has agreed to have snacks, but at the moment it is healthy snacks such as humus.  I know we can do better than that.  Based on what you and Tina are saying I will have another chat to d tonight and we will work out a plan to improve.  What do you think a realistic target weight should be for a 5ft 17 year old?


You can add oil and creme to humus. And add some crackers to it.
The chats might help you but will not really help to improve things. Your d does not need to want to get better to help her. She does not need to agree. See it like she has cancer. Would you chat with her first about every single day of chemotherapy or would you just sit besides her bed and say "here are your meds, please take them"? Food is her medicine.

I am really no fan of target weights. Feed her just until you see a constant change in behaviour. The percentile she was until about 1 year before ED moved in gives you an idea for the minimum. But that does not mean that you will see recovery at that point. A lot of patients need to go over former weight percentiles.
Keep feeding. There is light at the end of the tunnel.
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tina72
kloos wrote:
I didn't fully appreciate that the brain is an organ that needs healing in the same way as other organs.  That is a fascinating concept that I will defo take on board.


The brain is really a fantastic organ. If you would do the same damage to the liver or the kidney or the heart it would not recover and you would have a life time damage from that. The brain can renew the wires. The brain can heal itself. But only with good nutrition. Fat is the secret of brain recovery. At least 30 % of intake should be fats. Brain recovery is mostly biochemistry.

"I feel that this will be the new mantra in our house from today."
That is a very good mantra as you do not need any number and can simply require normal behaviour as recovery sign.
Keep feeding. There is light at the end of the tunnel.
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