Viewing blog posts categorized under "Recovery"

The Eleventh Hour

posted by Julie O'Toole on July 25, 2013 at 7:36pm

I’m sure all specialties have their frustrations, but here is a major one of mine: patients who come to Kartini Clinic needing -- indeed deserving -- help but at the “eleventh hour.”

 

What do I mean by this?  I mean families who come in seeking help for a condition which is characterized by anosognosia, having waited for a variety of reasons, until shortly before their child’s 18th birthday, at which age their child will be able to refuse treatment, and often will do.  Even in…

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Why do some people just get it?

posted by Julie O'Toole on July 18, 2013 at 12:28am

This is a tribute to two people who just plain “get it.”  And, you know, it can be hard to get.  I certainly know many professionals who deeply do not get it, and some who claim they do and yet who really only give it lip service.

The two people I am referring to are mothers of children with eating disorders; they are F.E.A.S.T. mamas, and they are filmmakers.  I am referring, of course, to Charlotte Bevans and Mary Gutteridge, the Bobbsey twins of enlightened animation.

And what…

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10 Steps to an Accurate Eating Disorder Diagnosis

posted by Julie O'Toole on July 11, 2013 at 12:59am

Inspired to think outside my usual box by Dr. Eric Topol, author of  Creative Destruction of Medicine this morning, I began to ask myself: how can I help parents who may not have access to experienced care, who fear that their child may have an eating disorder, make that diagnosis and get help?  Where do I start?

Well, start first with self-examination.  

We doctors are made very uncomfortable by any talk of patient autonomy or patient empowerment. The words “self diagnosis” are said…

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Who You Callin’ Fat?

posted by Julie O'Toole on July 3, 2013 at 10:50pm

Patient:  I have battled with my weight all my life, doctor.  It's my major health issue.

Doctor:  What does that mean, Susan?

Patient:  (irritated) It means, doctor, that I have been fat since I was a kid.

Doctor:  I see.  Are other family members overweight too?

Patient:  The word is fat.  F.A.T.  Let's call it what it is.  And no, they aren't.  I was adopted.

Doctor:  In that case, Susan, it seems reasonable to assume that your weight problem is not a result of anything you…

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Diet and exercise: the obsessions that will not die

posted by Julie O'Toole on June 27, 2013 at 6:27am

Aaargh! 

Although dieting has been shown repeatedly to be destructive, counter-productive and useless in most settings (i.e. you re-gain everything you lose and then some…), it simply will not die as a panacea for improving health.  The belief in weight loss/dieting and exercise as a health tool is so entrenched that people, even highly educated people, continue to insist that the emperor does have clothes, despite all evidence to the contrary.

I was happily reading over-due emails…

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Gene Mutations and the Weight Problems That Plague Us

posted by Julie O'Toole on May 30, 2013 at 2:10am

You’ve heard it everywhere: your friends, your doctor, the New York Times, your personal trainer, virtually anyone who talks to you about health for more than five minutes will give you the same litany:  we need to lose weight to be healthy and all we need to do to achieve that loss is to change what we eat (fewer refined high glycemic index carbs, leaner meats, more fish, better quality fats, etc.) and, ultimately, how much of it we eat -- otherwise we will not only get fat and look…

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The Day Treatment Model for Pediatric Patients

posted by Julie O'Toole on May 9, 2013 at 7:21am

With the publication of results for models of family-based home treatments, the treatment of children with eating disorders has changed a lot in the past five or six years, or at least it has in many communities.  In some places,however, it is still the “same ol’, same ol’” of individual eclectic therapy, nutritional advice and a doctor’s infrequent monitoring - a combination known for some time to give substandard results.  

For some patients  “Maudsley” and other forms of newer…

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Cook, My Darling Daughter!

posted by Julie O'Toole on April 19, 2013 at 9:14am

Cook, My Darling Daughter! is the title of a cookbook from the 1950’s I found in a secondhand bookstore and gave my eldest daughter as a young adult.  She had little experience of cooking, since in our family parents cook for their kids, and even though her brother and at least one of her younger sisters were determined foodies and excellent cooks, she had never been interested.  She was content to be fed, and since this was consistent with the culture of our family, her disinterest…

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In an article recently in the New York Times, author Harriet Brown reviews a subject that was hotly debated at the London International Conference for Eating Disorders by Glenn Waller, Roz Shafran and Howard Steiger, among others. The issue was what is called “evidence-based” interventions in eating disorders.

For example, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and family-based therapy (FBT) are  purportedly evidence-based interventions in the field…

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Selective Eating in Children

posted by Julie O'Toole on March 15, 2013 at 2:48am

[Ed. Note: a more recent blog on this subject can be found here).

There is a little talked-about pediatric eating disorder that I have not covered extensively in my blogs, nor is it covered well in most discussions elsewhere, including the various iterations of the DSM.  As a general pediatrician, like all other pediatricians, I ran into it, but it wasn’t until I read Dr. Rachel Bryant-Waugh and Dr. Bryan Lask’s  Eating Disorders: A Parents' Guide  years ago, that I was introduced…

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