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Levels of Care

posted by Julie O'Toole on April 16, 2014 at 4:49pm

At Kartini Clinic our evolution to the current levels of care we offer has been a long one.  In the first days of the clinic we offered only inpatient (hospital rounds for medical stabilization) and outpatient care.  In 2000 we developed the day treatment (partial hospital) level of care.  This was a big step forward and allowed us to “gently land” patients, who required brief medical stabilization in hospital, to a lower level of care. In day treatment, such patients could get a lot…

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Food phobia, the Kartini Clinic recipe

posted by Julie O'Toole on April 9, 2014 at 12:50pm

Talking to a mother whose son has just entered our Food Phobia treatment program I realized that I may not have done a very good job stating clearly what our “recipe” for success with this illness has been.  What can a parent expect?  What can a child look forward to?  What if a provider is forced to treat a child with food phobia in an outlying hospital; how might they proceed?

First, a bit about the diagnosis.

Food phobia is the term Kartini Clinic uses for the sudden onset of…

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Mixed Symptoms

posted by Julie O'Toole on April 2, 2014 at 11:10am

Recently I was making our daily rounds at Randall Children’s Hospital and received a lesson from a very young patient of ours.  I say it over and over: “your patients are your teachers”, and it is really true.  I was first told this by Dr. Mizuo Tottori, pediatrician and mentor to many other pediatricians in Hawaii. And life itself has borne out the truth of it, again and again.

This particular little patient has anorexia nervosa and has done very well.  Her parents are competent and…

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Looking For A Few Good (Wo)men

posted by Julie O'Toole on March 26, 2014 at 2:14pm

I’m not sure how many of you know it, but Kartini Clinic is looking forward to a major expansion.  We have signed the lease in a new building which will allow us more space for our kids and for the rather expansive ideas we are always coming up with.  We are continually looking for more ways to support our families, to integrate kids in the Day Treatment Unit (DTU) with their own schools, to improve the experience for families whose child needs medical stabilization across the street…

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Refeeding at Home

posted by Julie O'Toole on March 20, 2014 at 8:22am

I was recently asked by a professional skeptic, a parent & friend of mine, “why can’t parents re-feed their own children at home without the stamp of approval of the ‘professionals’”?

Well, they can, they DO, they SHOULD!  

Home re-feeding is ideal when it works, as virtually any intervention that can be done at home is preferable to one that requires the input of (even caring) strangers.  BUT -- and there are several buts-- it does not always work for several reasons:

  1. Example:…

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But For The Grace of God

posted by Julie O'Toole on March 12, 2014 at 2:32pm

When I was a girl, my brothers and sister and I had the usual kid-like responses to the world around us.  One of them was innocent astonishment at those less fortunate than we: the man at the bus stop without a leg, the “retarded” kid on the playground, homeless people.  If we were unwise enough to comment on them negatively in our father’s presence we felt the full force of his disapproval, the full weight of his teaching.  “When you see someone less fortunate than you, you are…

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What We Say Matters

posted by Julie O'Toole on March 5, 2014 at 4:18pm

I just returned from Tampa, Florida and the 2014 IAEDP conference of professionals involved in the treatment of eating disorders.  I was there to talk about the very young child with anorexia nervosa, and I was slated to talk for three hours. And talk I did. For three hours! That’s an unusually long presentation time, but I was surprised that the audience and I found plenty to say on the subject.  

At the beginning of my presentation I asked everyone to briefly state who they were…

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Thinking About Obesity

posted by Julie O'Toole on February 26, 2014 at 9:40am

Thinking about obesity: calmly, rationally and outside the box

When I was a rotating intern at Sacred Heart Medical Center, long ago, I attended rounds with the then head of medicine Dr. Patrick Tennison. Dr. Tennison was a thin, dark haired, intense guy who years later would save my life, but at that time was obsessed with imbuing young doctors with a sense of urgency about diagnostic dilemmas. He was more like a highly competitive detective than your typical doctor.  

“The main…

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Weight Restoration 2.0

posted by Julie O'Toole on February 19, 2014 at 5:59pm

At Kartini Clinic we have been embarking on something we call “weight restoration 2.0”.  In other words we are trying to move beyond mere weight restoration (as critical as that is) towards a deeper assessment of each patient’s full physical recovery.  We have noticed, over the years of faithfully weight restoring each and every patient, that people respond differently to recovery from starvation, depending no doubt on their genetics and on the duration of their illness. Just one…

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Why the basic sciences may save us all

posted by Julie O'Toole on February 12, 2014 at 3:10pm

In previous blogs I have spoken to the importance of bench science -- the kind done in the lab to decode the “basic” science that underlies human physiology -- to us as clinicians and to us as patients. And the branch of the sciences which explores the connection between bench science or lab science and clinical medicine, including mental health, is called translational medicine.

This last night I couldn’t sleep. This happens to me when I have any viral illness and I have learned to…

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