Silent night from the Blogosphere
I have been silent here on my blog over the Christmas and New Year’s holiday, traditionally a hard time for our patients.
Christmas and Hanukkah, with all of the candies and sweets and comments about weight and failed diets, can be a challenge for our patients—although I have been impressed with how calm it was this year.
Those who must spend the holidays in the hospital have had it especially hard. Families from the East Coast or other places thousands of miles away (Alaska!) have had to navigate the sadness of being in the Ronald McDonald House instead of at home with loved ones. Yet another example of the parental dedication our team sees every day.
And then there’s those New Year’s resolutions…ever noticed how many have to do with losing weight? What can I say? There are triggers for our patients everywhere.
Now that we are safely past those issues for 2009, what needs do we have? What would you like to see me cover in the next blog(s)? How can I be useful to you?
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I am currently in the CA DTU. Over the holidays I had a rough time. Our family lives all over the world and we only see them every 2 years. Well, for New Years Eve they decided to cook a big fancy meal. Being on the meal plan, I wouldn't be allowed to have any of the food. I was ok with this, what I wasn't ok with was waiting to eat. Dinner wasn't served until after 9 pm. It was an awful experience. I was hungry and wanted to eat, but I couldn't. I wanted to eat with the whole family so I chose to wait until they ate. I felt like I was being forced to restrict. I managed to sit through the dinner without any one noticing my mood, however I burst into tears after I left the table. The lesson learned- I'm important and I need to choose to eat when I get hungry. Whether everyone else is eating or not, that doesn't matter. I need to put myself first. If you have an ED, put yourself first, don't worry.
Thank you for sharing your college aged DTU (CA DTU) Christmas holiday experience with us. It is helpful for parents to hear from young adults about their personal experience with our program and the demands thereof.
I'm not clear which of the fancy foods would not have been allowed by your meal plan, but be that as it may, I think you have done a good job explaining how important it is that holiday food be handled in as predictable and structured a way as possible when a person is still early in their treatment.
Often other people, though well intended, do not understand why it can be difficult to manage emotions around the holiday food they regard as "wonderful".
Thanks for that
I don't know if this is blog worthy material, but I am curious to learn about the Rating of Eating Disorder Severity in Children (REDS-C) and how you apply it in your clinic. Also, how would one assess the criteria for a patient with AN-R to enter a day or outpatient treatment setting, and in which ways(if any) would treatment be different for a patient with AN-B/P?
Wow! Those are important and somewhat complex questions, but I will try and come up with the "Cliff notes": The REDS-C is an instrument which was developed to assess severity of an eating disorder in adults. It was developed by Dr Eliot Goldner of Vancouver BC and I modified it for children many years ago. For more information about the results achieved using REDS-C see our past News and Research piece on this subject.
We like it because it covers medical as well as psychological parameters and it is not just fill-in-the-blanks or self report. It is not different (in its consequences or implications) for AN-R vs ANB/P although those patients who binge and purge will usually get a higher score since a "restrictor" would score 0 for bingeing and and 0 for purging, etc. For children and youth it is not the REDS-C that determines the setting for treatment. The decision to begin someone in an inpatient setting is made on the basis of medical criteria established by the American Academy of Pediatrics which can be found on our website here.
We very, very rarely consent to start a patient in an outpatient setting who had an eating disorder severe enough to be seen in our clinic and to score as having an eating disorder on the REDS-C. Why? In our--by now fairly vast-- experience starting in an outpatient setting tends to work slowly and poorly and prolongs the time a young patient remains underweight, amenorrheic (if a girl old enough to have periods), socially isolated and obsessed with food. In our clinic "Outpatient" is very important, but it is something that is done after the Kartini Day Treatment Unit (KDTU). Time spent in the KDTU allows us to involve and teach the parents so that they are prepared to handle their job once they are in charge at home with less frequent visits to us. There is a lot to learn and we are committed to making family-based treatment work. Family-based treatment is not new to us, we have done only family-based treatment since the beginning of the Kartini Clinic. But it does take intensive teaching and review together. We have discovered that this approach will achieve remission for the overwhelming majority of patients within six months, as opposed to older formats where the patient was in treatment for years. The majority of those six months are spent in our outpatient clinic.
Of course, the longer a young person has been ill, the longer it can take to achieve psychological remission and for this reason we lobby hard for early recognition and referral.