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

Delivering Better Care

posted by Julie O'Toole on May 13, 2009 at 9:02pm

How can we do it better?


Clayton M. Christensen, Professor of Business Administration at Harvard Business School, in an article for CNN wrote:

"Patients want correct diagnoses and effective therapies, but they also value accessibility, convenience, transparency, communication and their time and money -- none of which have been priorities of the traditional health care model."

And I would add that while we at the Kartini Clinic (for example) think we are "transparent,…

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Bones and Anorexia Nervosa: osteopenia/osteoporosis

posted by Julie O'Toole on March 27, 2009 at 10:29pm

As we all know, weakening of bones is one of the most concerning effects of the malnutrition associated with anorexia nervosa (AN) in girls and boys.

What is the problem?

Osteopenia ("weak bones") is a precursor to osteoporosis ("bones full of holes"). It is not uncommon for a young patient with anorexia nervosa to present to their doctor with a stress fracture as the first manifestation of their illness. And sometimes even that gets ignored.

Many patients (especially boys) come to… Read More

Submissions for the Title: Most Ignorant Comment Ever

posted by Julie O'Toole on February 24, 2009 at 9:59pm
A note from the editor: We are pleased to announce the launch of a new feature to our blog that will allow viewers to leave comments and share their thoughts with us and each other. Simply enter your comment at the bottom of the this page. All comments will be approved by our moderator before being posted. Please always be appropriate and considerate of others' opinions and feelings. Thanks.


Submissions for the Title: Most Ignorant Comment Ever

Today in the clinic I saw one… Read More

And you think we have it bad…some consolation

posted by Julie O'Toole on February 9, 2009 at 9:06pm
It is no secret to anyone who is breathing that our economy has taken a few terrifying turns these past four months or so and has slowly but surely begun to affect everyone. When parents get laid off, they lose their health insurance, not to mention any leeway they had in their budget to seek medical care for themselves and their children. In the case of Kartini Clinic parents, in the past, one parent could afford to seek family medical leave of absence to engage in family based… Read More

Dr. Brazelton on Self-Esteem in Children

posted by Julie O'Toole on December 19, 2008 at 9:12pm

Happy Holidays and Holy Days to all our Kartini Clinic friends. This blog is a quote from one of my "most admired" pediatricians and another doctor named Joshua Sparrow on the subject of "self esteem", a term I have come to hate for its over-use. As usual, Dr Brazelton has something useful and instructive to say on the subject. I would encourage you to google him for other pearls of wisdom.

I am blogging on self-esteem today because our patients, although they do have eating…

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“Water weight”

posted by Julie O'Toole on October 17, 2008 at 8:35pm

Water Loading Before Appointments

In my previous blog I discussed falsifying weight by wearing weights. This time I would like to discuss a much more common circumstance in which a patient falsifies their weight by trying to drink a lot of water before they are weighed. Often this is done because they know their weight is down (since they have been secretly restricting or exercising), or they are afraid their weight is down and are anxious that the doctor or parents not find out.
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Wearing Weights

posted by Julie O'Toole on October 7, 2008 at 9:41pm
I remember the first time a patient of ours was "caught" wearing weights. I was examining her with her mother and a young resident pediatrician in the room. I noticed that her weight was up, but she looked terrible! So I thought to myself: back to basics, re-examine her carefully in case you have missed some physical sign, maybe she has grown in height and weight has not caught up… I repeated her physical exam with an eye to re-assessing her pubertal development. I asked… Read More

Returning to college

posted by Julie O'Toole on September 3, 2008 at 3:28am
I got off the phone with a college student health doctor last week with the sinking feeling that I get when I have not been able to convey the rationale for what we do here at Kartini Clinic. Let me give you some background: college-aged youth with an eating disorder who graduate from our Day Treatment Program and return to college face many hurdles to remaining in good remission. We long ago learned that we are not able to manage them from afar and therefore make every effort to… Read More
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