Family Dinner

posted by Julie O'Toole on October 20, 2009 at 9:33pm

It's 1959, a mild day in California and we kids are playing outside.  There are four of us and four of our friends, we range all over the neighborhood and small community park without concern for our safety.  We laugh, we shout, we quarrel, we play.  And then it's over:  "Kids! Time to come home….dinner's ready".  Up and down the block mothers were calling their children indoors.  It was time for dinner in America and pretty much everyone stopped what they were doing and ate. …

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Weighing our children

posted by Julie O'Toole on September 30, 2009 at 3:22am
At the Kartini Clinic we tell our parents (over and over again) "Please don't let anyone one, even another doctor's office, weigh your child while they are in treatment here." Why not? Well let me tell you why not: I walked into the exam room to see my patient, a young boy who had had a very rocky road to remission. He was barely stable physically and just had one toe in psychological recovery. He had struggled. "I had a bad week" he told me in a quiet, shamed voice, "I had a… Read More

The Many Disguises of an Eating Disorder

posted by Julie O'Toole on August 20, 2009 at 2:09am

It's not every day that I have an epiphany about anorexia nervosa.  But today I was (re)taught something by a young man I know, respect and treat.  It wasn't entirely new information — I had been taught something similar by younger patients in the hospital -- yet I had apparently either forgotten it or not realized its full implications until today.

That epiphany is this:  severe eating disorders can present in many guises beyond the obvious ones described in the DSM-IV and in…

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Will Somebody PLEASE help my child? He’s spitting out all food!

posted by Julie O'Toole on August 11, 2009 at 4:03am
I have blogged on food phobia before, but today it was two desperate phone calls from across the country that spurred me to revisit this issue.  The ages of the children this week were three and four and a half years old respectively.  Very young.  Their families did not resemble each other much, but the stories of their children's illness were very similar.  

And just an hour ago I saw a young patient whom we will call Sean.  Sean had food phobia; he is completing his course of…
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I Don’t Have Anorexia! No comment.

posted by Julie O'Toole on July 31, 2009 at 9:43pm

Scene:  hospital bedside, the doctor is making rounds.  The patient, a 16 year old boy, is in his hospital bed having been admitted earlier that day.  His mother is next to him.  In tears.  He is angry and tearful himself.  He is well groomed, clean and tidy, good-looking but very, very thin with obvious muscle-wasting.  His heart rate, although he is angry, is in the 40's, at night it drops to the low 30's.  He is too orthostatic to stand.

"Jacob," the doctor says, "I'm here to…

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The Future of Psychotherapy

posted by Julie O'Toole on July 25, 2009 at 2:19am
The Future of Psychotherapy for Mentally Ill Children and Adolescents by John S. March is not the kind of article I usually read — or so I thought until our psychiatric nurse practitioner here at Kartini Clinic, Janiece, put it on my desk (Janiece Desocio PMHNP, PhD, and a distance professor at the University of Rochester). Now all I can say is "Wow!"

It's a dense article with big concepts like "translational developmental neuroscience" and "epigenetic amelioration", but what Dr.… Read More

Oregonian Article on Eating Disorders

posted by Julie O'Toole on July 13, 2009 at 9:10pm
On July 8th The Oregonian ran an article about eating disorders featuring a large, glamorous photo of a "recovered patient": a beautiful young woman in a slim dark dress and long blondish hair leaning against a leather couch in a well-appointed home.

Were her parents proud of her? You bet! Should they have been? Absolutely!

Is it a good idea for her and for their readers for the newspaper to have run this huge photo and for the article to explicitly state weight she had lost and… Read More

Healthcare Reform and You

posted by Julie O'Toole on July 6, 2009 at 9:09pm

[editor's note: from time to time I invite other staff members to write about issues I think may be of interest to our families. This week's guest blog is written by Morgan O'Toole, and concerns healthcare reform, specifically the possibility of a "public option" health insurance plan, a topic currently much in the news. He adds his own two cents' worth here. In the interests of full disclosure I should point out that Morgan is my son, and is responsible for the day-to-day operation…

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Eating “too much”

posted by Julie O'Toole on June 23, 2009 at 7:49pm

I just read a parent's thread on Laura Collin's FEAST website called "Eating Too Much". It made my hair stand on end. And it clearly resonated with more than one parent on the FEAST site.

It is the old story of a weight restored child with anorexia nervosa continuing to eat a lot and moving up way past their weight goal. Both the child and the parent are panicking.

I feel like the person who has been yelling: "Don't drive down that road it ends in a cliff! Don't drive off the…

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Take time to smell the azaleas…

posted by Julie O'Toole on June 10, 2009 at 4:02am
I am a gardener when I am not in the clinic. It used to be that I did all my best thinking in the shower. Now I do it in the garden. So some musings from there. Thinking about stress today. Stress and our patients. What does the word stress mean for all of us? The two doctors are stressed from the drip-drip-drip responsibility that never lets up of having to do rounds in the hospital 365 days a year. The patients are stressed from…… having to deal with us…..having to eat when… Read More
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