Thursday, 15 October 2009
After our fist visit to the Maudsley, Waif stuck gaily to her eating plan. There was some negotiation: "Mummy, I don't want two icecream fingers, can I make the second one a biscuit?" or "Mummy, I am having a chocolate bar for a snack instead of just a fruit juice, so I can have one less thing for breakfast" but generally there was compliance and I felt very relieved.
So it was disappointing to discover, on returning to the Maudsley 2 weeks later, that she had lost a 0.5kg. The psychiatrist was at pains to point out that no diagnosis had yet beenmade (??how did that square with him telling me on the phone that Waif had EDNOS (eating disorder not otherwise specified).
After weighing (once again he seemed surprised at the result and he cross checked with a second pair of scales), he took her off for an hour to chat. Waif reported he was just asking her about books and films. He strikes me as ineffectual, and very young, but perhaps he has a cunning master plan. He did however sensibly suggest that Waif should keep a food diary. Waif expressed horror at the extra work this would involve when she already feels overcommitted and we compromised on her doing it for a week before her next fortnightly visit. She started it 3 days ago.
Meanwhile, I have returned to work and school has restarted. I ask Waif daily what she ate for lunch and she usually trots out the correct answer of "pasta and bread and pudding" or somesuch. I have been unbusy at work so have managed to return in time to cook her supper each night.
If (big if) Waif is being truthful about what she has eaten, then perhaps there is after all a physical reason for her weightloss. As I may have mentioned before (sorry, I am getting behind on this blog) I took her back to the GP to have her neck lump re-examined as the Psych had thought an ultrasound would be a good idea. However, the GP was very reassuring: it is definitely a goitre - a lump on the thyroid gland- and inactive as her thyroid function blood tests were normal - so no further tests were needed. However just today, the doctor at A&E (more explanation later) opined that we should return to the GP and ask for an ultrasound.
The latest comment on my last post gave me great pause for thought, as well as being incredibly moving. I think it is right that an anorexic child is going to be deceitful so I am not ruling out Waif rushing off and being sick after meals, or not eating AT ALL at school :-(
Older daughter has had flu this week, progressing from a cold last week, and so has been off school (meaning that I have had to miss work even though I am just back). Waif, whilst not seeming as ill - she had no temperature on Monday and Tuesday - has also been off ill as she has not felt up to going in. I have thought this not such a bad thing as I can feed her up at home. But yesterday, Waif too developed a temperature and a cough, and this morning she woke up unable to breathe properly. Luckily she was in bed beside me as she would not have been able to call. After a brief wrestle in my mind (car or ambulance?) I put her in the car and raced to A&E. Typically, and mercifully,she had recovered by the time we arrived 4 and a half minutes later (quicker than an ambulance would have got to us I reckon, and cheaper for NHS and less embarrassing) but I took her in to be seen anyway.
I am quite sleep deprived myself, having been staying up with Older Daughter as her temperature remained resolutely at 39.5C through the nights, and could not even get Waif's date of birth correct at the hospital so they took a while to locate her records. First I realised I had the date and month reversed, so corrected that (feeling a fool), then, when they still couldn't find her but "could" find a child with her name and birthday who was born in 1994, I realised I had given Older Daughter's year of birth. D'oh, it's just as well I don't intend to give anyone legal advice today.
The doctor on call sent Waif for a chest x-ray which disclosed a chest infection. The doctor also used some word meaning lumps of stuff in her lungs (I have forgotten what it was, perhaps "contusions" or somesuch). He has prescribed her 2 anti-biotics and said that she was borderline for IV antibiotics and so I was to bring her straight back if she deteriorated or failed to improve on the drugs. He said that she was malnourished and that is making her vulnerable to infections.
It is now 7.44am and I have mince pies in the oven which I am about to force feed the Waif (joke, I hope, but I will put her under pressure to finish them). The antibiotics might apparently give her a dodgy tummy so I am hoping all will stay within long enough to be digested.
At 9am I shall go to cash in the prescription. I will no longer go to our corner pharmacist after my experience picking up cough linctus for Older Daughter on Tuesday: the girl doing the dispensing there was clearly NOT a trained pharmacist. She is usually behind the counter taking payment. She is very sweet but her youth, lack of articulacy and dizziness betray she is not a pharmacist.
The qualificiation and registration certificate on display at the pharmacy is for an Indian man. I asked her whether she was a pharamacist and she said she was a "pharmacy technician" and was supervised by the pharmacist. The pharmacist was in a different room, 0ut of sight. I imagine she is quite competent but I would rather have someone with 5 years training dispensing my drugs and not some YTS student. She willingly and cheerfully held up the bottles she had used in proof of the fact that she had dispensed the right drugs. Obviously, I did not have time to check the concentrations without taking a rude amount of time so I held my tongue, smiled, and accepted the bottle. She was a nice girl but I threw the cough linctus away. It has not been unheard of for a pharmacist (a proper one, with qualifications and training) to question a doctor's prescription dose and to be able to give useful advice in tandem, so I shall go to the other pharmacy nearby for Waif's antibiotics.
Oh, I weighed Waif yesterday and she has dropped to 35.5kg :-( :-(
PS It was "lung consolidation" not contusion.