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On Individualized Treatment

posted by Julie O'Toole on July 8, 2016 at 10:11am

I was reading an online opinion piece by one of my colleagues, Dr Ovidio Bermudez, who like me is an adolescent medicine physician and eating disorder doctor.  This one sentence jumped out at me since it reflects what I have said in many ways before, only Ovidio said it better and more succinctly: “Families like to hear that care is tailored to their loved one’s unique recovery need, but core principles of treatment, including symptom interruption and weight restoration, should not…

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Practical re-feeding hints for parents: Benecalorie®

posted by Julie O'Toole on June 30, 2016 at 12:37pm

This blog post is about a useful, if prosaic, product we use in the initial phases of re-feeding at Kartini Clinic. I hope this post is helpfull to parents looking for feeding alternatives for their child with an eating disorder. And I would prefer to report on a generic product, but I have not found one: Benecalorie® is made by Nestlé and sold as a nutritional supplement. We have found it extremely useful when we need to add calories but do not want to use sugary additions such as…

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Binge / purge anorexia vs. bulimia: a DSM 5 update

posted by Julie O'Toole on June 23, 2016 at 10:20am

It has now been three years since the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published and it’s time for an update to previous blogs on this topic (which have been replaced by this update).

Many people say: “I used to have anorexia and then I developed bulimia,” or “She has anorexia and bulimia.” These statements are not accurate, and stem from a common misperception that any purging (vomiting) means a patient “is bulimic” or “has bulimia.” More…

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Is Anorexia Nervosa a Chronic Illness?

posted by Julie O'Toole on June 16, 2016 at 12:30pm

Recently, while responding to a struggling parent who had posed a specific concern on the F.E.A.S.T. website, I used the word "remission." Another mother on the forum responded that she did not like my use of the word "remission" since she preferred to think her daughter's illness was not chronic. Until that moment it had not occurred to me that this question of chronicity was a controversial one for some parents.

Ken Nunn, neuro-anatomist, eating disorder specialist and great…

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Kids are just kids

posted by Julie O'Toole on June 9, 2016 at 8:00am

As some of you already know, at Kartini Clinic we specialize in children and teens with all conditions of disordered eating—but our deepest specialty is children ages 12 and under.

Yesterday I went upstairs to the youngest patient group, which we call the “Fire Group” (Earth, wind and….) to bring them a present I had promised them. At any given time in Fire we have kids with, and those without, nasogastric tubes. We have nine year olds with food phobia, ten year olds with failure to…

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The challenge of family based treatment for college aged youth

posted by Julie O'Toole on May 26, 2016 at 12:52pm

The acceptance and success of family based treatment interventions in the world of eating disorders has been one of the major mental health breakthroughs of the past few decades. Empowering parents to be in charge of re-feeding and in charge of helping their child with anorexia nervosa achieve weight restoration has been a resounding success, especially for the child who is still young enough to be dependent on their parents for schooling, food and shelter. This means children…

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Avoidant Restrictive Food Intake Disorder (ARFID)

posted by Julie O'Toole on May 19, 2016 at 10:31am

In the 2000’s and even earlier, it became apparent that the systems of classifications used to define eating disorders were inadequate to describe the entire spectrum of clinical presentations, especially in children. In the UK, Dasha Nicholls famously wrote: “Children into DSM don’t go,” and I couldn’t have agreed more.

A new classification is established

Then, finally, the DSM was changed to reflect some consensus about pediatric eating disorders among those of us who - across…

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Going Forward: Early Recognition Remains Our Best Defense

posted by Julie O'Toole on May 12, 2016 at 10:40am

June 2nd, 2016 will mark the first World Eating Disorders Action Day, an internationally-recognized day during which members of the eating disorder community, including affected individuals and their families as well as researchers and policy makers, have united virtually to increase access to accurate information, eradicate myths and collectively advocate for resources and policy change. Kartini Clinic is honored to have been asked to submit a blog post about our hopes and goals for…

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Getting Help

posted by Julie O'Toole on May 5, 2016 at 1:17pm

When the care you’re receiving just isn’t good enough

The other day I received a call from a distraught sister-in-law who was visiting my niece, her daughter, in a developing country where this lovely young woman had gone to have adventures and live in a rural setting. My niece had developed a high fever, chills, vomiting and pain in her back, over the kidneys. From a faraway doctor’s point of view, the most likely diagnosis was pyelonephritis or a kidney infection. There followed a…

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As I have said many times in the past, complete weight restoration is the conditio sine qua non of childhood eating disorder treatment -- if you do not get weight restoration, you will get nothing. While facilitating weight restoration, there are a number of biomarkers (in addition to weight gain) we monitor at Kartini Clinic to help ensure our patients' adequate physical and hormonal restoration.

Pubertal Girls: Restoration of Menstruation

In a girl old enough to have periods or…

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