Dulwich Park and the Maudsley again

Given the glorious weather at the weekend, Waif made us all a picnic and insisted we went to Dulwich Park, whih was a fab day out.

Here is H at our picnic spot:

and here is Waif out boating with Older Daughter and a friend:

and then Waif went on the Victorian fairground:

The dog was a bit worried about Waif at this point  ;-)    They are pretty devoted to one another.

Waif has been eating well and less fussily - she now allows me to put cream cheese in her smoked salmon sandwiches and has eaten a few potatoes recently, tempted by the new season Jersey Royals.  At the picnic, she ate a large slice of pizza and then had an ice cream after boating.  Mind you, she needed the energy because after we arrived home she cycled to an hour's tennis coaching and back.

All in all, life has been less fraught and we have al been more relaxed at mealtimes so it was great at the Maudsley this afternoon to find that Waif had nonetheless put on 400g and now weighs in at 41.4kg (fully dressed).  This is the same as the visit before last and is, in itself, a record.

We are going for more of the same - trying to introduce some chips this time and continuing to eat healthily.  Waif is starting to look well, although she will look even healthier if she puts on another 5kg.

New Scales

I picked up our new "super accurate" Weight Watchers scales last night and Waif had her weigh-in this morning before breakfast which is when she should be her lightest, and in only a light nightdress (whereas at the Maudsley she wears her heavy uniform).

My husband stood on the scales last night and was shocked to find he was 13 st 7lbs.  He is 6ft 4 so 189lb gives him a BMI of 23 which is in the middle of the healthy range.  Nonetheless, he is determined to lose weight now.

I stood on them this morning and found that I weighed in at more than I had ever expected!  I went upstairs to our old (Balance) scales on which I was then 5lb lighter.....hmmmm......I have had the bathroom scales a long time and always found they correlated with the gym scales pretty well.....I was already doubting the accuracy of the new "super precise" within 100g read - out on the new ones.

Ho hum, anyway Waif stepped aboard and the readout was 6st 7 lb.  We couldn't at that moment find a way to make it read in kg so didn't really know what that meant.  I have now discovered it is 91lb which is 41.3kg.   I would be surprised and pleased if this were not an overly high reading.  Bearing in mind that Waif was 41.0kg last Thursday afternoon in full clothes (?1.5kg) and straight after drinking 500ml of smoothie and eating two chocolate bars.

I guess it's not important as it is only the trend that counts but I want to do some research on the accuracy of those scales because leading Waif to believe she weighs more than she does could be counter productive as we near her full weight goal....      Could Weight Watchers make their scales weigh heavy to encourage people to join up? Is that a very cynical thought?

Our weekly weigh in will be Mondays henceforth.  I am aiming for Waif to weigh 42.8kg next Monday.  If she does, then I will celebrate  :-)

Waif has a lot of incentives to get to a healthy weight - a French exchange trip to Paris and the Loire in July, a ski-ing holiday in December and the need to be 2 years recovered to go to boarding school for the sixth form.    She has continued to eat well - at least as far as aa I know - I only witnessed breakfast and late night snack yesterday but Waif had earlier allowed me to put a little mayonnaise in her lunchtime cheese and tomato sandwich and hungrily ate her morning fishfingers.  Actually Older Daughter took Waif to Pizza Express for supper.  When they returned, OD came to tell me that Waif had had a tomato salad as starter and half a vegetable lasagne for main course.  I then found Waif and said she needed pudding (sponge and ice cream) and she tried to argue that she had had a very big starter so didn't need pudding.  I told her that tomatoes have next to no calories and that she HAD to have pudding.  She did  :-)  but had I not been home, I have no doubt she would not have.  Independence is still a way away.

Redoubled efforts

A picture of our local park that I took in early Autumn.

Thank you to my various commentators uniformly coming across with the message that I have to take this ED more seriously - that's exactly why I wanted to start this blog:  to hear advice from others who have direct experience and/or knowledge.

You will be glad to learn that I have redoubled my efforts and Waif has eaten enough food to sink a battle ship these last 3 days.

I have ordered a pair of scales (as recommended, ironically by Weight watchers) which I am picking up tonight from our local Tesco store. Waif wanted digital so that there were no disagreements about readings and parallax errors and also because she (wrongly) confuses precision with accuracy.  Nonetheless, these were the most obviously accurate scales I could find with a digital readout. We are supposed to weigh on a Monday morning but the base reading will have to be tomorrow (Tuesday).

I was particularly pleased to receive a link in one of my comments to some incredibly informative videos by an expert about caloric needs in recovering anorexics.  Apparently, whilst ordinary people need between 20 and 40 kcal per day per kg of body weight to maintain a steady weight, a recovering anorexic needs about 50 kcal just to maintain weight.  Waif at about 40kg therefore needs 2,000 kcal a day just to remain as thin as she is, without allowing for weight gain.  This explains how she seems (genuinely) to be eating more than anyone else in the family and yet not gaining weight.  The extra is thought to be burned up as heat and patients often report being burning hot at night.  Now that I understand that, I am aiming at more like 3-4,000 kcal a day.  That takes some doing especially when there is still resistance to fatty foods (fried foods, cream sauces etc).  That resistance is also normal -apparently anorexics develop a dislike for fatty foods whilst developing a craving for the sweet.   Waif also seems to be buying into the idea that she must recover more quickly, not least as we have talked about how she needs to have had 2 years at a normal weight before she can live away from home and she is keen to follow her older sister to her world famous outstanding boarding school for the sixth form.

400g loss  :-(     and that was with Waif drinking 2 smoothies on the way to the appointment  :-(

She has grown another 0.5cm and her overall % (wahtever that is) has gone, over the 9 months of therapy, from 77.9% to 82.5%    This is up, which is fantastic, but still within the anorexic range of sub 85% and not merely underweight.

We talked about how this might have come about.  I was totally honest about Waif's exercise - cycling to school, tennis lessons, the occasional swim and school PE and asked if we should reduce this.  The psych, surprisingly said no.  She said that Waif needs to learn how much she needs to eat whilst living a normal, active life and doesn't want her to put on weight only when sitting vegetating in front of the TV because then when she restarts normal activities, she will lose weight again.

So the only option is to increase the foodplan.  We decided to add a large piece of cake on.  I suggested lunchtime but the psych thought that tea would be better as food eaten at home seems to count as more.  Waif, surprisingly, agreed that tea would be better than lunch.

We are also adding in an additional late night snack of cheese and biscuits.

THe psych noticed that the food that Waif avoids (potatoes, including chips, mayonnaise, biscuits, cheesecake, cheese, pastry and all pies) are all the high energy foods that an anorexic might choose to avoid as perceiving that they are high calorie and advised that Waif needs to begin eating these foods normally.

I wondered whether we should be monitoring Waif's calorie intake to ensure it is over 3,000kcal a day but the psych said not.  She said that it is not good for anorexics to count calories as that makes them worse.  Of course, the first thing Waif does whenever I buy a new food is to check the packet for the calorie information and, if it is home made or I have thrown away the packaging, go on the internet for information.

THe first time I bought her cheesecake, about 3 months ago, Waif gobbled down 2 slices and I thought I had a result (as that was about 600 kcal in one snack) but the next day claimed she didn't like it.  The same thing happened in November when mince pies came back into the shops for Xmas.  Waif has always loved mince pies so I bought a couple of boxes.  Again, Waif wolfed down the first couple but by the next day (post internet searching on calorie information) claimed she no longer liked them.  So when Waif yesterday ventured that she didn't know about calories, I pointed this out and she didn't argue with me.

Instead of talking about "high calorie" food, the psych carefully talks about "high energy" food, in a positive way.  I shall try to emulate that.

In the end we decided as I have explained, on adding even more food to the meal plan.

It now reads as follows:

Breakfast

2 pieces of toast
2 fishfingers
Bowl of cereal and milk
apple juice
yoghurt

Mid morning snack

A doughnut
A juice

Lunch

sandwich
crisps
smoothie or yoghurt drink
apple
chocolate bar

Afternoon snack
cake
2 pieces of toast
hot chocolate or ice cream

Supper
50g cheese or 100g meat or 150g fish
150g carbohydrate
100g vegetables
sponge pudding and ice cream

Late night snack

200ml milk drink
2 biscuits or 2 pieces of toast (Waif always picks the toast - with no topping)
Cheese and biscuits

We have also decided to have weekly weighings.  The psych suggested we came to the Maudsley for that but it is quite a performance so I asked if we mightn't do the weighings at home.  Waif was keen on that idea too. The psych said that weighing at home can cause conflict but both aif and I thought this unlikely and want to give it a go - the psych agreed.

We are having the next 2 appointments fortnightly, then a 3 week break as the psych heads off to the Himalayas.

I am about to go online to buy a pair of accurate scales - Waif wants digital.  Waif wanted the weighings to be in the evening but the psych said they had to be first thing in the morning, which we are doing on Mondays.

Maudsley again

We have our visit to the Maudsley this afternoon.

Both Waif and I begin to get edgy before a visit. Both worrying about weight gain.  Waif said to me yesterday "Mummy, I don'think I have put on any weight this time".

I assured her that if she had been eating all that she was supposed to then she was bound to have put on weight although I agreed that she didn't look any heavier.

Aside:  Last week, she went in to the school shop to try and buy a second school skirt (in a smaller size - the school starts at 4 years old so they have all sorts)  and the man in the shop refused to sell it to her.  I am not sure why but she was very embarrassed and now wants me to buy it for her.  I have told her that it's not a good idea to be buying smaller clothes and that I would rather she grew into the skirt she has and am happy to buy her a second one if that is what she needs.

Anyway, Waif said that she had been eating everything.  I said that in that case, if she hasn't put on weight, we need to reduce her exercise and increase her calorie intake.  She then asked me for a week's grace, but I said no, if she has not gained then the cycling will stop.   I am now fearful that Waif may have actually LOST weight.

Meantime, Waif has apparent concerns over her teeth (so she says).  She has replaced hot chocolates with milk, which I can see is better for her teeth but represents fewer calories.  It's tricky but honestly I do realise (and thank you for all the comments) that weight gain is of prime importance and teeth can be fixed (ish).  Last night, she agreed to eat something exta as she had been swimming.  She chose an applie.  I pointed out to her that 3 biscuits would be more calories at wich she c=became very tearful and said she was worried that she never got to eat anything healthy as she was so busy eating junk food.  I tried to explain that with the amount she is supposed to be eating, she has plenty of chance to get enough "proper" nutrition - vitamins, protein, calcium etc AND eat biscuits, but she still ate only the apple  :-(  

Meanwhile I am trying to analyse my own motives for being keen on cycling to school and am wondering if I am being selfish - I enjoy the cycling myself, I do feel it's better for the environment and it saves a lot of money on petrol.  This last point concerns me - I can't honestly say that the saving doesn't influence me - about £40 a week I reckon with our high consumption car and the price of petrol as it is.  But if someone said to me that to make Waif better would cost £1,000 per week then of course I would gladly pay it, so why does it concern me?  Why can't I ignore it?  I am guessing that perhaps that is partly because I am on sabbatical from work and so not bringing in a wage and so feel that it is not my money to spend.  How stupid is that?!  

Life goes on

Waif has been a little tired and emotional recently.  I do hope she is not overdoing things.  She has been eating more independently (round at other people's houses for tea, our with a friend etc) so Thursday (Maudsley weigh-in) will be telling.  I am hoping that the tiredness is not a reflection on not eating enough.

My good friend, the child psychiatrist, asked me last week how on earth I was letting Waif cycle to school every day when she is still so thin.  She asked me what the Maudsley thought.  Being absolutely honest, I am not sure that I have fully covered the point at the Maudsley but my general impression is that Waif is to be given as much freedom as is compatible with weight gain.  I guess if she has not gained any weight on Thursday then cycling will have to stop.  I am certain she has not gained the requisite 3kg in 3 weeks, but maybe 500g.  I am happy with slow and steady if it is being attained with a good, healthy, nutritious diet and exercise.  I fear that if it is all chocolate and ice cream then Waif will struggle to know what is a normal "maintenance" diet at the end of it and I def don't want her yo-yoing.

Meanwhile, she is doing well at school, coming top in lots of subjects:  maths and science as well as english and french.  Waif has asked me to give her extra coaching at home as she doesn't feel stretched at school and doesn't want to go backwards.  I had a look at her maths and saw she was doing second order difference in quadratic based sequences.  This isn't even on the GCSE syllabus, only iGCSE so I reassured her that it was without doubt progress.  Meanwhile, now that she is a little stronger, I will try to find some lectures for us to go to together - I often go to the Royal Institution for science lectures and Waif fancies the Royal Geographical Society for geography talks.  We went there not long ago for a talk on prime numbers by Marcus du Sautoy and it was great.

Meanwhile we have been going backwards on some fronts - Waif was back in our bed on Sunday night although okay again last night.  She has also taken to following me around the house - she likes to be in the same room as me at all times which is terribly sweet, and I love it, but it's possibly not normal for a 13 year old.

I just finished reading a book called "Skippy Dies" by Paul Murray which is set in a boys' boarding school in Ireland.  |There is a girls' convent school next door.  In a minor sub plot, one of the girls gets lured into a sexual encounter with a boy (planned, aided and abetted by a different girl) and is so traumatised by it that she stops eating and ends up being hospitalised for anorexia.  Her parents cannot understand her behaviour and attribute it (wrongly..ish) to the death of her friend Skippy.  It makes me wonder if anything traumatic has happened to Waif that she has not shared.  I do hope not.  I do hope she could tell me anything but every parent hopes that and it's rarely the case.  Perversely, perhaps it is even more difficult to talk to a parent who believes you to be wonderful as you might worry that you could burst their bubble.  Actually, nothing Waif could ever tell me would make me love her the tiniest iota less.

Risk taking and back to work decisions

Here is our new bike tent in the garden, to save having bikes in the house :-)

Hmmm...Older Daughter is worried about Waif. She (OD) said to me this morning that she heard from a mutual friend that Waif never has her morning snack. I asked her at breakfast -

"casual talk, casual talk, so Waif, casual talk, casual talk, what have you been having for your morning snack lately?"

She said a doughnut or two large cookies. Hmmmm....... she didn't sound very convincing.

OD also toldme that I needed to talk to Waif about the facts of life. Apparently Waif has been saying that you "will most likely be okay" if you have sex without a condom. Whilst I hope that, at 13years old, sex is many years away, that kind of attitude towards risk is concerning.

Similarly, when pulling out into traffic today (only coming off a bike lane and into the traffic, so not crossing any lanes) I reminded Waif to look over her shoulder first.

"Why should I?" she replied.

"Because there might be a car or van coming".

"Well, they ought to slow down for me" she said.

Whilst clearly Waif is right, equally clearly she is the one who will come off worst in an accident.

Waif has also been implementing a new tactic of delay:

"Oh, I am not having much for lunch because we are going out for supper". 


"Oh, I won't have a snack here in Starbucks because I prefer what we have at home."

Of course, being deeply fallible, I often then forget to supervise that later on the calories are truly being made up. Having said that, I DO supervise the breakfast fish finger sandwich and bowl of cereal, the 2 glasses of milk in the afternoon and supper, including pudding. Hot chocolate is now off the menu, replaced by a glass of milk btw. I guess that's okay even though it is less calorific.

The next Maudsley appointment is Thursday of next week. When we were last there I asked the psych how most anorexics eventually recover in light of the fact that she said that most do not recognise or fully accept that they are ill. She told me that they eventually get fed up with coming to appointments and having meals dominate their lives and so, effectively, give in to pressure. I guess that is why the success rate is better for younger teens than older, as the adult pressure is less easily resisted.

That same day I am due to go to annual drinks for my team at the law office from which I am on sabbatical. This brings to mind the fact that I am due back at work in September and need to decide what to do. Whilst Waif is SOOOOO much better, I wonder how she will fare if I am once more out of the house when she arrives home from school and often not back until 7.30 or 8.30pm. My husband is almost never home before 9pm. Older Daughter will not even be here for company as she will be at boarding school by then. Hmm.....perhaps I need to find a way of working from home. Perhaps I should give up my job and do something completely different. The time has rushed past.