Viewing blog posts categorized under "Recovery"

Re-training the brain and modifying behavior in eating disorder treatment

posted by Julie O'Toole on March 18, 2012 at 1:11am

Ah the brain, it's so complex; we are so complex!  What of our behavior is under our control?  What is amenable to cajoling, influence and even coercion? Does this change with age?  How is general willingness and ability to learn affected by a specific brain disorder, or can we generalize?

These issues quite frequently come to the fore during the treatment of food phobia, and even infrequently in the treatment of early onset anorexia nervosa.

Some percentage of our young food phobia…

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Exercise and the Severely Anorexic Patient

posted by Julie O'Toole on March 2, 2012 at 11:15pm

On February 18 I attended the annual conference of the Columbia River Eating Disorder Network (CREDN) and heard Dr Ken Weiner of ERC speak there.  Ken spoke about the uselessness, hopelessness and mirage of dieting, but he also spoke about some of the issues pertinent to managing the patient with anorexia nervosa.

In Dr. Weiner’s experience, and the experience of his colleague Dr Craig Johnson (founding editor of the International Journal of Eating Disorders and founding member of…

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Coming from afar

posted by Julie O'Toole on February 3, 2012 at 2:00pm

This week I have had the privilege of treating a young person whose parents moved heaven and earth to fly them across the entire United States to seek what they believe to be the best care available anywhere.

Can you imagine how humbling that is for us?  To be thought the best care by parents who are entrusting you with the most precious thing they have: their child?  It’s not that they come with stars in their eyes and “yes doctor, whatever you say” written cross their…

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A wolf in sheep’s clothing

posted by Julie O'Toole on January 20, 2012 at 2:00pm

Every researcher in the field of eating disorders tries their best to reduce the burden of suffering for patients.  They try to contribute to the meaningful scientific discussion.  Having said that, however, I am going to proceed to critique an article by Natalie Godart, Sylvie Berthoz, Florence Curt and colleagues at the Institut Mutualiste Montsouris in Paris, France; the French National Institute for Health and Medical Research; King’s College, London Institute of Psychiatry; the…

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Richard Morton’s Description of Anorexia Nervosa in a Young Man

posted by Julie O'Toole on January 6, 2012 at 2:00pm

This is the second and final case presentation Dr. Morton makes of two illustrative examples of anorexia nervosa.  This time it is a young man.  He mentions that the patient is the son of a friend—so imagine how motivated he was to establish the correct diagnosis and find a successful treatment! First Morton discusses the differential diagnosis, establishes the correct diagnosis, discusses failed treatments and finally discusses his successful treatment of what, to him, is a chronic…

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Safe Eating Using the “Magic Plate”

posted by Julie O'Toole on December 9, 2011 at 2:29am

Magic PlateI am often surprised and pleased at the way we—pediatric providers who believe in the biological basis for eating disorders and parents who are caring for their children-- stumble our way forward trying to make things work and find ourselves on the same track.

I was given this lovely plate after the FEAST conference, by a mom, with the following kind words:

Dr. O'Toole,

Thank You for believing in parents and for all your hard work and dedication in the treatment of EDs, and…

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Inpatient Eating Disorder Treatment Checklist for Parents

posted by Julie O'Toole on December 2, 2011 at 2:00pm

If your child or adolescent is admitted to a hospital for the medical complications of an eating disorder, you need to carefully assess adequacy of care at that hospital.  

Common sense would dictate that we not become aggressive, belittling or demanding of professionals on whom our child is temporarily dependent for medical intervention, however you should not hesitate to inform yourself, rely on your intuition and experience and ask questions.  The days of “because I said so and I…

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Don’t take no for an answer

posted by Julie O'Toole on October 28, 2011 at 3:00pm

I made this dialogue up, pieced it together from things that have been said to mothers and fathers seeking our care for their eating disordered children many times over the years.  

“Doctor, I am really worried about Simon.  He seems thin to me and recently all he does is study and exercise, he rarely goes out with his friends any more and he used to be such a social kid.”

“Don’t worry, Mom.  Kids go through all kinds of stages.  They have to experience who they are and often try on…

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Making medical rounds on our patients

posted by Julie O'Toole on October 24, 2011 at 10:59pm

Life for most pediatricians used to be pretty well defined: you got up early and made hospital rounds on all your patients—mostly newborn babies and an occasional hospitalized child—before you went to see patients in the office.  Day in and day out, rounds were the rhythm of a doctor’s life. For many of us “making rounds” meant driving to more than one hospital to see everyone, so the day started early and was highly predictable, if a lot of work.  Most physicians trained in the era…

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Readers of this blog know that Kartini Clinic offers inpatient medical stabilization, partial hospitalization and outpatient care, all entirely family based.  We do not offer residential care.  However, we find ourselves occasionally forced to refer a patient for residential treatment despite the fact that residential care is by its very nature not family based and despite the fact that the patient will ultimately have to return to their community and family and try to stay in…

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