Wednesday, 23 September 2009

fall out

Waif is still in bed, 36 hours after her Maudsley visit.

Yesterday she had a sore throat and headache, no doubt due to her continuous crying :-( Today, she has a tummy ache.

She is reluctant to go in to school because she says that she won't learn anything and will just be miserable as she is in pain. That seems like a reasonable argument. I will, however, put her under gentle but firm pressure to head back to school tomorrow as I don't want her to miss so much school that catching up will put her under stress. I am not sure whether her pains today are viral, but at least her mood is improved.

I took her to her GP yesterday, as suggested by the Maudsley doctor. The GP agreed that Waif has a lump on her neck, but is certain that it is a harmless goitre - a swollen thyroid gland that is not uncommon in puberty. Her gland is not one that is overactive as her blood tests were normal so he said not to worry about the lump as long as it remains soft and mobile.

I wonder if it is affecting her swallowing.

The Maudsley psychiatrist kindly phoned me back. Waif is begging me not to take her back there: she says that she is now eating sensibly (she is, and already looks healthier after 10 days) and wants me to promise that if she puts on weight then I will cancel future appointments.

I asked the psychiatrist whether perhaps I was inadvertantly medicalising a normal part of Waif's growing up. He agreed that her questionnaires showed none of the markers of Anorexia Nervosa apart from the weight loss: she is not depressed, not anxious, not concerned about body image etc. This convinces them that she must be hiding things, or else suffers from EDNOS (Eating disorder, not otherwise specified)....hmmm...she doesn't seem to fit into the Wikipedia categories.

I am worried that she may have some sort of underlying wasting physical condition that is not being explored because a psychiatrist is instead looking for some kind of deep psychological trauma. Waif is in a Catch 22 situation because they won't believe her when she tells them there isn't one. Waif reckons they are 'giving' her emotional trauma by trying to put words into her mouth eg the psychiatrist asked her which chocolate bars she liked, and she said that she didn't really eat chocolate bars. He then pressed her to name a favourite so she said Mars bars (I have never known her eat one). Then later in the interview, the family therapist (nicely, and with a smile) suggested Waif was fibbing by saying that she (the FT) doubted Waif really ate Mars bars as she claimed.

Hmmm... although I quite liked the family therapist who seemed firm, experienced and direct, I was not sure about her intellect. She told Waif that the criterion for anorexia was a weight:height ratio (or some such term) of 84% or less, and Waif's was 77%. She then sought to explain this by saying:

"So, Waif, do you understand? That means that if we took one hundred girls your height and age and lined them up, then..then....." She petered out, confused.

"then you would be the first in line because you are in the first centile" I helped out after an embarrassing silence, realising that the FT was confusing centiles with her weight:height ratio thingie (which scale I must track down...I shall ask my friend who is the borough child psychiatrist and also treats anorexics).

Even non-numeric husband said afterwards he thought the FT was daft at this point as he couldn't imagine why you would line up 100 children where the fattest would be "normal", and the thinnest would be weightless, and Waif 23rd in the line, as FT appeared to be doing. I was surprised as I would expect an ED specialist to be familiar with the various types of scale and measurement. Fortnunately, the psychiatrist said that it would be he alone who conducted the future consultations. Perhaps they have decided we are too functional to need a Family Therapist.

Sigh, I hope I don't sound ungrateful. It is a marvellous thing to have access to the best service in the world for Eating Disorders, I just hope it is the right place for Waif. Half of me feels that we should be able to sort this out intra-family but the logical part of me knows that I was failing on that front as Waif has lost 10% of her body weight SINCE I have been trying to encourage her to eat more.

Ho hum, I have agreed that Waif should attend her next appointment at the Maudsley on Friday next week. This is the last day that I have on sabbatical, and I will be back at work the week after, so future visits will be very awkward unless they are on Mondays (my day off).

Meantime, I am advertising locally for someone to be home after school to cook and supervise the girls' supper.

1 comment:

  1. I guess the one thing that you have going for you is that you don't need to guess, or surmise about whether things are working or not: you have an unambiguous scale that tells you, every few days, precisely whether she is getting better or worse, whether your decisions are helping or not, whether your approach is working or not: Her weight of course.

    From reading your blog seems like she has been losing weight for four months, almost uninterrupted despite all your attempts to help.... until you got to the point when you made an appointment at the Maudsley, and since then she has been gaining.

    So far so good then, and chalk up the Maudsly as a positive.