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Kartini Clinic

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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Anorexia Nervosa meets Thanksgiving: It’s A Mess

posted by Julie O'Toole on November 17, 2016 at 8:41am

This post was originally published on November 23, 2010.

Thanksgiving is one of my favorite holidays. As is probably true for many of you, it's all about giving thanks, and in our own family we have a lot to give thanks for this year, not least for a tiny new granddaughter (3 weeks) and a healthy, happy grandson (one year old this weekend). It's also important, in my view, to have a holiday that focuses on gratitude, especially when life gets challenging, as it does for many of our…

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How to weigh an eating disordered child

posted by Julie O'Toole on November 10, 2016 at 8:01am

This post was originally published on November 30, 2010.

Reading through the latest comments on Laura's Soap Box, and those on Around the Dinner Table message board, I see many requests for educating medical professionals in the community about eating disorder treatment. "Colleen" says, for example:

"We still don't have any effective professional guidelines for treatment. My doc can't go to any definitive reference source and find a 'recipe' of what to do once he's made the…

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Collaborative Medicine: Inching Our Way Foward

posted by Julie O'Toole on November 3, 2016 at 9:39am

Inching our way forward into medical care that is truly collaborative, we face many challenges.

The first is internal: our medical training (pretty much no matter when we trained) reflects a very long history of “doctor knows best”-- not because doctors have an ingrained desire to be seen as superior, but because they like to be seen as heroes. War has been described as “long periods of boredom punctuated by moments of sheer terror,” and this could, in some ways, describe the life…

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