Today I was seeing a young patient who had just been cleared to resume her sport activities.  At the start of the appointment she was nearly trembling with anxiety, for the results of her labs were to determine whether or not the timing was right for her to return to volleyball.  Fortunately (for all concerned!) the labs were good and I could clear her.

“But I still need to know something,” her dad said nervously “Honey, how will we know if your eating disorder is returning as a result of this increase in your physical activity?  How will Mom and I be able to tell?”

There was a brief silence.  I nearly broke it, but before I could, my patient leaned forward intently.

“Let me tell you how,” she said.  

“If you see me isolate myself from my friends, be worried.  If you see me unable to relax, be worried.  If you see me obsess on the volleyball stats to such an extent that I can’t stop and enjoy anything else, you know I’m in trouble.”

Wow!  I thought.

“And” she went on “Dr O’Toole would let you know if I have lost weight.  If I lose weight, we know there’s a problem.  If I get orthostastic we had better search for the reason why.”

She sat back:  “that’s how Dad, that’s how.”