Thursday, 13 May 2010

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?!  


  1. One thing to bear in mind that the MOST helpful intervention for bone and tooth health in anorexia nervosa is weight gain. Of course, a young person with anorexia nervosa can't be expected to choose to eat higher calorie foods, but that's truly the best medicine for anorexia and it's related medical complications.

    With regard to cost, maybe it makes sense to focus on doing all you can while on sabbatical to help your daughter to health? It seems you have an opportunity for monitoring meals, insuring high calorie consumption, etc. The longer the course of malnutrition, the greater the cost in treatment over time is likely to be. (The cost in quality of life and missed development while ill isn't as easily measured, but it stands to reason that these costs are higher as the illness drags on, too.)

    Good luck!

    Int J Eat Disord. 2009 Apr;42(3):195-201.
    Treatment of osteopenia and osteoporosis in anorexia nervosa: a systematic review of the literature.
    Mehler PS, MacKenzie TD.

    Department of Internal Medicine, Denver Health Medical Center, Denver, Colorado 80204, USA.
    OBJECTIVE: To systematically review the evidence supporting treatment of osteopenia and osteoporosis in patients with anorexia nervosa (AN). DATA SOURCES: We identified controlled clinical studies of interventions for low bone mass in AN via searches of MEDLINE; the Cochrane Library; EMBASE; PsycINFO; and cumulative index to nursing and allied health literature. Outcomes of interest were changes in bone mineral density and fracture incidence. RESULTS: Six randomized controlled trials (RCTs) and two cohort trials examined five classes of medical therapy on bone mineral density outcomes. One RCT of bisphosphonates showed no benefit and a second flawed RCT showed some benefit; one RCT showed a benefit of insulin-like growth factor-I; none of the five trials evaluating estrogen therapy showed benefit. DISCUSSION: Although patients with AN are often losing bone mass when they should be optimizing bone growth, there is no good evidence to guide medicinal interventions. Therefore, early detection and weight restoration are of utmost importance whereas ongoing trials define effective therapies. (c) 2008 by Wiley Periodicals, Inc.

  2. Please be 100% TRUTHFUL at the Maudsley appointment.
    If Waif was in hospital, she would be doing basically no exercise.
    Do not let it get to that point,please.

  3. Anon: thank you for the advice and the useful references. Another reality check for me and it MUST be right. I am really, really gunning for a 2kg increase in the next fortnight. It must be achievable.

    Jennifer: thank you, I took your heartfelt advice and volunteered full disclosure at the appointment. THe Psych basically said normal activity is fine as long as it is not obsessive (and it's not). It is def harder though to put on weight whilst exercising but we are redoubling our efforts.

  4. You might want to check out this video on caloric requirements for weight gain in anorexia, especially the influence of exercise. It really takes a lot to get the job done.
    (Also, it's a simple matter to brush teeth after chocolate milk!)

  5. Anon, that was a brilliant link, thank you. It explains how Waif might indeed be telling the truth about how much she is eating (which perhaps I had begun to doubt) but in fact needs to increase her calorie intake further simply to maintain weight gain in the face of increased metabolic rate. I am working on it just as hard as I can. It's incredible that an anorexic has to eat TWICE as much to maintain her weight as a normal person.