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

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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kpmama
Hi
My daughter has been diagnosed with AN 3 months back. She is a freshman living in a dorm in California and we live in a different country. She was asked to go for IP but she refused because she was worried about losing the semester and hence was put on a meal plan with regular check ups with doctor, dietitian and therapist. We got to know about her condition only in March and before we could come to terms and decide on any treatment plan, covid struck. She has moved to a family friend's house and cannot come back home because of travel bans. She really wants to go for the IP as she is struggling. We have arranged for a therapist from our hometown through skype thrice a week. But still she says she is restricting and exercising. We want to know how safe is it go for IP now. Also, after the treatment, it will be a problem if she can't travel back home or to her aunt's house in Michigan. We are in such a helpless condition! Please advice...
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Enn
Welcome to the forum and so sorry you needed to find us. It must have really been a shock to learn about the ED recenty.

I understand how hard this can be with her so far away. You state she is living with aa family friend. Does this friend know her about her illness? Is this friend able to support your d in helping her eat more and stop exercising? If your family friend wishes to join the forum as well, we could support her with ideas help your d.
Please read around the forum there is a big learning curve with ED.
Please read the FEAST-ed.org site. There are a lot of resources there. 
Anorexiafamily.com is another good site.
While she is so ill, school should really take a back seat until she is better. Here in Canada all school is on line right now and end at the end of April. I am not sure what is going on where your d is.
Does your d have an ED team where she is now? Are they able to do Skype visits for her? IF they feel that IP is required even during COVID, then I think that is the right thing to do. 
Please ask all the questions you have. I am so sorry for all that you are all going through at this time. 
Sending a hug.
🤗 
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
Welcome to the forum. This must be so hard for you, being so far away and unable to be with and care for your daughter. It is great that you have managed to get her to a family friend. As Enn has mentioned reading widely and your family friend reading widely about ED may help everyone. 

It is normal for those with ED to find recovery very difficult. It sounds like you have managed to get a support team together. If things are not improving then IP may well be the next best step. This will still be hard for your D. For many the difference between IP and being outpatient is the sense that there is no choice in complying with stopping activity, eating all meals and snacks. It is one of the reasons why FBT does work well for some, the principles of full nutrition are the same. 
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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Kali

Dear Kpmama,

What would be a very difficult situation is made even more difficult right now by the pandemic and my heart goes out to you.
This is a large country and I would be reluctant to advise whether or not going to residential at the moment would be safe due to Covid19.
It really would depend. However, it is a positive sign that your daughter is agreeable to going to IP and being in treatment.

Here are some things to consider:

Her overall health and whether or not she is medically compromised. Does she have access to an MD who is familiar with eating disorder?

Are you in close contact with the family friends she is staying with and how would they describe what your daughter is going through and what is happening with her? 

Is it possible to arrange for the family friends to eat with her on a regular basis so that your d. has some accountability?

Is it possible for you to video chat her at some of her mealtimes and eat "together"?

What is the opinion of the therapist she is working with?

There are some very good centers in the US. Many families have spoken highly of ERC in Denver for example. Another treatment center highly spoken of in California is UCSD Eating Disorders in San Diego. You could try to get in touch with them and inquire about their programs and how they are handling things due to the public health crisis, if you want to try and make a plan. There are also FBT therapists who will work with patients via video chat and work with young adults, such as Dr. Sarah Ravin in Florida. It says on her website that she will do parent consultations as well, if you want to see if you can get some ideas about how to proceed:

http://drsarahravin.com/clinical-services/parent-consultations/

I really understand how terribly worried you must be. My daughter also became ill the first year of college and went into treatment. She took a year off and worked on her health. I hope you and your daughter will be able to work out a plan. 

We are here to support you.

warmly,
Kali

Food=Love
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kpmama
Hi, 
Thank you for responding so quickly! I will try to explain better so that you can guide me better...
"Does she have access to an MD who is familiar with eating disorder?"
...No. Her college doctor wanted regular calls her d refused as she feels the doctor would not be happy as she is not following the meal plan. I cannot ask my friends to take her to a MD given the shelter-in orders and already they are doing a lot by taking care of her. It has been 3 weeks since she had a check up. 

"Are you in close contact with the family friends she is staying with and how would they describe what your daughter is going through and what is happening with her?"
...Yes. They say she seems normal. They go for walks together (which also helps to stop d from jogging). They eat lunch and dinner together and sort of monitor  what d is eating. But d is not willing to take their help as eating coach. 

"Is it possible for you to video chat her at some of her mealtimes and eat "together"?"
...I do talk/video chat with her multiple times in a day. She allows me to take care of two snack times, evenings and nights. I talk her thro' those sessions. Breakfast is on her own but since that is time my friend is in the kitchen cooking, there is a bit of accountability there as well. Morning snacks completely out as I am not able to make her eat. 

"What is the opinion of the therapist she is working with?"
He feels he needs a co-therapist there to work with. Till then it is more of a "maintenance" mode. Or, since it has been only 6 sessions till now, he is still trying to understand d's cognitive and behaviour patterns. 

In fact it was d who suggested this website to me! She said she has written to you earlier asking for help. We tried contacting the Centre for Discovery in Fremont for telehelp IOP. But she was not accepted because of low BMI. We are terrified to send her to IP,  given the coronavirus situation and she'd be all alone (as we cannot impose more on our friends to take care of this). D also feels that online help isn't really "helping"! So we are stuck...
Please suggest... 
Thank you once again...


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Foodsupport_AUS
This is really such a difficult situation. Asking some friends to take on the role of caring for your D at this difficult time is definitely a big request. At the same time other than your D going inpatient there may not be a lot of other choices. The fact that she was refused admission to an outpatient program for low BMI suggests things are quite critical. 

No talk therapy is going to get your daughter to eat her meals and follow the meal plan. When ill it is normal for someone to need coaching and guidance for every meal, and every bite. If your friends cannot help your D to complete this, or she can't be coached from afar then she would need to go somewhere where this can happen, that may mean needing to go inpatient. 

It can also help if your daughter has little say in meal preparation and meal choice. Although initially she is likely to refuse this, sometimes being relieved of the choice as to what to eat can be a  big relief. Her only requirement is to eat what she is given. 


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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Kali

kpmama,

I remember your daughter and she seems a kind and intelligent girl who expressed that she wanted help and wanted to become well again and to be able to continue at her college (where I have no doubt she is an excellent student and that she will have, when the eating disorder is under control, a bright future). She reminded me of my own daughter.

For the time being, can you have a talk with her and let her know that you love and support her and that she needs to do her best to listen to everything you are telling her she must do and it will help her move toward recovery—and that you understand it will be very difficult for her but it is critical that she do so. Be a loving and calm voice of authority helping her to move in the direction of remission.

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"Does she have access to an MD who is familiar with eating disorders?"
...No. Her college doctor wanted regular calls her d refused as she feels the doctor would not be happy as she is not following the meal plan. I cannot ask my friends to take her to a MD given the shelter-in orders and already they are doing a lot by taking care of her. It has been 3 weeks since she had a check up. 


First, and very importantly, she really should follow up with her doctor and have regular calls as he/she had wanted. You can stress that she needs to follow the instructions of the professionals even if it is very difficult for her to do so and ask that she make that appointment as soon as possible and that she follows through on it. You could also ask her to include you on the call, if there is a way to do a three way call. Striving for openness and honesty during this process will help your daughter.

Do you know what range her weight is at the moment?

There is also a nutritionist on the west coast who is very well respected in the eating disorder community and has a lot of experience working with young adults with eating disorders. Perhaps your daughter could set up a meeting with her and receive some meal coaching and nutrition/meal plan advice in that way? I believe she will work with patients remotely.

Therese Waterhous

https://www.willamettenutritionsource.com/therese-waterhous-experience.htm

And most importantly, she needs to keep eating. It does not sound as though she is refusing all food which is a good sign. When my d. was in treatment one of the ways they helped them restore weight (in addition to three meals a day) was for them to drink a drink called ensure for snacks between meals. Perhaps if she is struggling with snacks right now that would be a good thing for you to try and address. You could have her supplement her food intake in this way and video chat with her. If you are video chatting, can you eat along with her? Another snack you could suggest which has a small footprint would be a granola bar and a smoothie, for example. 

I want to give you hope because it is important to remember that eating disorders are treatable illnesses. It is important to intervene to help your daughter as best you can at the moment. 

Let us know how it goes and please greet your daughter from me and give her my best wishes for her to beat this thing!

warmly,
Kali

Food=Love
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mommiful
I see you mentioned Center for Discovery in Fremont. Is your daughter in the San Francisco Bay Area? You might want to reach out to the UCSF eating disorders program for advice and a possible assessment. They have an excellent reputation, similar to UCSD, and offer a range of services.

Don't be too scared of her going into an inpatient program, in the sense of a medical stabilization program at a hospital. If a doctor says she needs inpatient treatment for medical stabilization, it is essential and should not be disregarded, even out of fear of coronavirus. Residential programs (i.e. 24-hour programs without the level of medical support available in a hospital setting) and day programs (like IOP and PHP) are not necessarily better than re-feeding at home, which it sounds like you might be able to do with a combination of remote support and the help of your friends. 
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camusicmom
Due to coronavirus, many centers are offering more virtual programs.  Check out:   https://www.eatingrecoverycenter.com/virtualcare

Unfortunately, my d is in residential right now.  The center is taking every precaution to ensure the safety of the patients.  Including:  all staff wear masks and temp taken every morning; new patients wear mask for 14 days; no in person parent visits (brutal) but virtual
visits; the second someone has a fever or a cough - they go into isolation.  All of this is to say, if you think IP or residential is the right step, please don’t delay because of coronavirus concerns.
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