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Depression

posted by Julie O'Toole on February 16, 2017 at 9:30am

In the treatment of children and adolescents with eating disorders, depression is a not uncommon finding. Sometimes we identify it on admission to Kartini Clinic, sometimes it has already been identified before the patient ever saw us, and sometimes it is a residual of otherwise successful treatment. The latter is especially frustrating.

There is a saying in medicine, “when you leave the appointment feeling depressed, you know the patient's diagnosis.” Which might be why many…

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Resting Your Athletes

posted by Julie O'Toole on February 2, 2017 at 9:43am

Oh God, it’s so hard. Hard for the kids. Hard for the parents. Hard for me.

Resting an injury is not an easy concept when you don't feel direct and immediate pain if you don’t. This makes it hard to rest an injury such as a heart attack, cancer, a surgery or… anorexia nervosa. And it’s harder for some people to rest than for others.

Case in point: my partner pediatrician Dr. Naghmeh Moshtael. I know she won’t mind me revealing that she has had to undergo chemotherapy several times…

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Can Complex Disorders be Extinguished?

posted by Julie O'Toole on January 19, 2017 at 9:48am

When I was a pediatric resident in Honolulu, Hawaii, I had the great and unusual opportunity to spend time with patients with a condition now largely unknown to most American doctors, except in text books: leprosy, or Hansen’s Disease, as it is more properly termed.

Behind Diamond Head is a small hospital whose history is described as “...a community’s quick response to the serious threat of the bubonic plague... In an effort to halt the spread of the plague, houses were burned, and…

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Why Can’t Everyone Get a Good Result?

posted by Julie O'Toole on January 5, 2017 at 10:03am

Anorexia nervosa is a complex illness, like most illnesses that involve the brain. There is a wide spectrum of severity, ranging from cases that easily turn around with re-feeding and seem to disappear for good, to those that are  crippling and debilitating for an entire life.

I think it goes without saying that neither the patient nor their family are to blame for which form the patient has been afflicted with (mild, moderate, severe, chronic disabling)-- but in case there are a…

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Why Weight Restoration in Eating Disorder Treatment Must Come First

posted by Julie O'Toole on December 29, 2016 at 8:46am

This post was originally published on February 13, 2012.

I (among others) have recently been challenged by Laura Collins to get the message out that weight restoration is critical to psychological recovery in anorexia nervosa. Some authority, Laura says, must declare definitively that psychological recovery is tied to weight restoration.

Some authority… okay… but who?

Since the late 1990’s the AAP (American Academy of Pediatrics) has issued guidelines for hospitalization (after…

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Home Away From Home

posted by Julie O'Toole on December 20, 2016 at 1:59pm

If, like me, you have a roof over your head, heat, light, internet and food, reflect for a moment on how fortunate we are.

Many people mistake their good fortune for virtue, believing themselves to be so lucky because of their “good choices,” but that is often far from the mark.  

During the Depression, my father’s family lived in a mountain village in rural Utah, had a roof over their head, some light and heat, but rarely enough food. No one was lazy, no one was in jail, they were…

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Talking Back To ED

posted by Julie O'Toole on December 15, 2016 at 10:12am

In general I do not especially like using the trivializing nickname “ED” to refer to a punishing condition like anorexia nervosa , but many of our families do. Perhaps this popular shorthand allows them to get their minds around an entity that has hijacked their child’s life-- and with it their own-- and which dominates every conversation they have at home.

We teach our parents to “externalize the illness,” that is to separate their child from the condition to help the parents…

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Treatment Fatigue

posted by Julie O'Toole on December 8, 2016 at 9:26am

I feel so weary writing this, I almost can’t start. And I am not talking about provider fatigue, for that is a different subject altogether, and an important one. No, I mean the fatigue I have watched parents feel over all these years of treating children with eating disorders.

Parents are human, even when they can do inhumanly difficult things for the sake of their children. None are saints, of course, but they can come close to sainthood when circumstances require. At least, some…

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The Misuse of BMI in Diagnosis of Pediatric Eating Disorders

posted by Julie O'Toole on December 1, 2016 at 8:00am

Parents, doctors, therapists, dietitians and patients: don’t even think about using BMI as a measure of “state!”

You have heard me say in my blog posts many times that, at Kartini clinic, we try to focus on “state,” not “weight.” That is, the state of good health as opposed to a given weight. As measures of this state of health, we use our metabolic labs, including measurements of thyroid health, sex hormones, leptin, glucose, insulin, cortisol and others. We also look at the return…

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Giving Thanks

posted by Julie O'Toole on November 27, 2016 at 2:19pm

Late in the afternoon on the day before Thanksgiving, a mother of a former patient emailed our clinic and here is what she said:

She wanted to call and let us know how grateful she is and how well her daughter is doing. She said that her daughter graduated from college, has been teaching kindergarten for about three years, and just recently got married.

Every year, around Thanksgiving time, she gets very emotional and always gives thanks for our clinic, since it helped them so much…

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